Form-I APPLICATION FOR CONSENT FOR EMISSION UNDER SECTION(21) OF THE ACT (SEE CHAPTER-11) To THE MEMBER SECRETARY T.S. Pollution Control Board, Paryavaran Bhavan, A3, IE, Sanathnagar, Hyderabad. Sir, I/We apply for CONSENT under section(21) of the Air(Prevention and Control of Pollution)Act,1981(14 of 1981) to make emission from industrial plant owned by (1) or occupied by. (2) Srikakolapu Laxmi Narasimha Murthy for a period upto (3) I/We further declare that the information furnished in the Annexure/Appendices and Plans is correct to the best of my/our Knowledge. (4) I/we hereby submit that in case of change either of the point, or the quantity of emission or its quality a fresh application for CONSENT shall be made and until such consent is granted, no chamnge shall be made. (5) I/We hereby agree to submit to the Board, an application for renewal of CONSENT one month in advance of the date of expiry of the consented period for emission, if to be continued thereafter. (6) I/We undertake to furnish any other information with in one month of its being called by the Board. (7) I/We enclosed here fee details. D.D NO. Bank Name Amount(Rs) (8) The Annexure, appendices, other particulars and plans are attached herewith in triplicate. Signature Name of the applicant: Srikakolapu Laxmi Narasimha Murthy Address of Applicant: MEDCHAL II,Shamirpet,Devaryamjal,8-101/3,Devaryamjal,500078 ANNEXURE TO FORM - 1 CHIMNEY Note: Any Applicant knowingly giving incorrect information or suppressing any information thereto shall be liable for action under the provisions of the Act. While filling this Annexure the applicant shall for such of the items not pertaining to his activity shall state not applicable against the relevant item and shall not leave it blank. 1. (a) Full name of the applicant with address: Srikakolapu Laxmi Narasimha Murthy (b) Name and Telephone No. of persons incharge of the premises: 2. (a) Full name of the industrial plant with address: M/s Andhra Polymers (P) Ltd.,MEDCHAL II,Shamirpet,Devaryamjal,8-101/3,Devaryamjal,500078 (b) Full name and address of the occupier (defined in Srikakolapu Laxmi Narasimha Murthy the Act ) as Registered with the Director of Factories & Medchal,Shamirpet,Devaryamjal,8- Boilers of the State or with any other competent authority 101/3,Devaryamjal,500078 of the state. : 3. Give revenue / city survey number of land/ premises for which the application is made stating District/ Mandal and Village. (a) Mandal : Shamirpet (b) Village : Devaryamjal . (b) Magisterial Jurisdiction of the industry (premises) for purposes of prosecution case under the Act and also the name & address of the Police station under the industry (Premises) falls for all criminal cases connected with the Water Act, 1974 or Air Act, 1981. 4. State month and year in which the industrial plant was 10/04/2019 actually put into commission or is proposed to be put into commission/or the month and year from which the local body is functioning 5. (a) State the civil/Military Defence/Industrial Estate Collectorate etc., under. Whose administrative jurisdiction the occupiers industrial plant is situated. 6.Elevation above mean sea 7.Present use of the Land Agriculture 8.Indicate the nature of topography Plains Surrounding Plains the site. 9.(a) State whether the industrial plant has been declared Not-Selected as prohibited area. (b) If Yes, State the name of the authority and furnish a certified copy of the order which the area has been declared as prohibited. 10 Which of the following features exist within 20 kilometers radius of the site.: Feature Name Distance(in Km) 11. Is the industrial plant of the occupier closed on Not-Selected Sunday/Holiday 12.State working season per year of the Industrial plant. From Date To Date 13. Climatological & Meteorological Data (1).Indicate the climatic conditions at the site(eg Arid, Semi Arid etc.): (2).Precipitation, yearly average range: (3).Temperature, Seasonal ranges: (4).Average annual speed and direction of wind Humidity/Solar radiation: 11.Raw material used Sl. No. Description Quantity Units 1. Rubber Sheet and 12000 Kg/day Strip 15(a) Products /waste material Sl. No. Name of The Product Capacity Units 1. CV Line Rubber 10000 Kg/day Products 15(b) By-Products /waste material Sl. No. Name of The By-Product Capacity Units 16.Complete flow chart giving description and-chemical process if any as per Annexure-I 17. Fuel Consumption in T/day S.no. Types Daily Calorific Ash Content Sulphur Other Specify Consumption Value % Content % in Tonnes 18. Furnaces/Cupolas/Boilers/Others Stack Name Used for Type of Date of Capacity Purpose Method of Quantity of Furnace/cup installation used Fuel Fuel used in olas/Boilers/ charging in Boilers Others Boilers 19. Emission control equipment for air pollutants Stack Used For Status Not Nature of Efficienc Capacity Details of Give Any Name Existing the Air y Air detailed other Pollution pollution specificat monitori Equipme Control ions of ng nt System cyclones, facilities Electro available. static Precipita tors, Scrubber s, Sag Filters etc. 20. Atmospheric Emissions (Stacks Details) Stack attached to D.G Stack height Gas Quantity (Units) Fuel Gas temprature Are any Standard of Set Emission prescribed for or adopted by your Industry? DG set 320 KVA 10 Yes (a) Fuel Gas Emissions Stack Used For Type of C fuel/hr Ash % NOx SO2 HCL CO Particulat Name Fuel e matter (b) Atmospheric Emission for Process & Fugitive Sources S.no Stack Name Stack Temperature( Expected Proposed Air Are any Height(in 'C) Quantity Pollution Standard of mtr) Control Emission System prescribed for or adopted by your Industry? (c) Process Emissions Stack Name SO2 CO2 CO NOx Hydrocarbon Particulars Others specify (d) Particulate analysis Stack Name Chemical Give details of Flue Give details of Is there sufficient composition gas sampling Laboratory facilities space available for arrangements available for installing Air analysis of emissions Pollution Control Equipment 21. Solid Wastes Nature Quantity Mode of Disposal 22. Any relevant information not covered in the above items : 23. Water Source S.No. Source Type Source Name Quantity 1. Borewell and Ground 0.6 HMW&SSB 24. Average daily consumption of water Sl. No. Purpose Quantity Unit 1. Others Cooling (re- 0.1 KLD circulated) 2. Domestic 0.5 KLD 25. Waste Water Discharge : SI.No. Purpose Quantity Units 1 Domestic 0.4 KLD 26.Treatment Features Before Treatment After Treatment 27. State the total quantity of air handled by ventilation equipment so also specify size and No. of equipments installed to be installed (a) Location and Dimension of Outlets (i) Fuel Gas Emissions Stack Type of Quantity S % Ash % NOx SO2 HCL CO Particulat Name Fuel of fuel e matter (ii) Process Emissions Stack Name SO2 CO2 NOx Hydrocarbons Particulars Others Specify 28.Give the following details (a) Total investment in the factory and the year of investment. (b) The estimated expenditure for implementing the project (c) Expenditure incurred to date and process achieved (Physical) for air pollution control, if any and the year/years of investments-along with physical process achieved: (d) Annual operation and maintenance of air pollution control plant. (e) Further action that is being taken by the firm to control Air Pollution. 29.Other relevant information : Place : Signature Date : (Name & Address of the applicant) .