[Operate/Renewal]
RED/ORANGE
Duly completed form alongwith necessary attachmentss are to be submitted in single copy
Tripura State Pollution Control Board
Parivesh Bhawan, Pandit Nehru Complex, Agartala, Pin:799006,Tripura
Ph-232246/2222455/2328792, Fax-(0381)-2225421
Application for Consent to Operate
for
Red Plus, Ordinary Red & Orange Category Industry/Operation/Process/Activity
Application under Section 25 and section 26 of water(Prevention and control of Pollution) Act,
1974 and under Section 21 of the Air(Prevention and control of Pollution) Act, 1981 for Consent
to Operating Industry/Operation/Process/Activity requiring discharge of effluent and causing
emission.
Date of Submission :21/01/2025
To From(Name and address of the unit)
Member Secretary ASTHA PATHOLOGICAL LABORATORY
Tripura Pollution Control Board Sonamura
Agartala Dainik bazar, Near Fish Market.
SIPAHIJALA
Sir,
With a view to operating an Industry/operation/process/Activity, I/We hereby apply under
(i) Section 25/26 of Water(Prevention & Control of Pollution) Act, 1974 for disposal of
sewage/ trade effluent/ any other effluent on land/ water body/ river (after pretreatment for
conforming to prescribed standards),and
(ii) Section 21 of Air(Prevention & Control of pollution) Act, 1981 for release of emission into
atmosphere (after pretreatment for conforming to prescribed standards)originating from
M/s ASTHA PATHOLOGICAL LABORATORY owned by Samaresh Paul for its unit
located at Sonamura,Dainik bazar, Near Fish Market.
2. The Annexure, Appendices, other particulars and plans are attached.
3. I/We further declare that the information furnished in the application form,
Annexure/Appendices and plans is correct to the best of my/our knowledge.
4. I/We hereby submit that in case of a change either of a point or the quantity of discharge or
the quantity of emission, a fresh application for consent shall be made and until such consent is
granted, no change shall be made.
5. I/We hereby agree to submit to the board, application for renewable of consent one month
in advance of the date of expiry of the consented period, if to be continued thereafter.
6. I/We undertake to furnish any other information within seven days of its being called for by
the State Board.
7. I/We enclose herewith following Bank Details in favour of Member secreatary, Tripura
State Pollution Control Board being the 'Consent to Operate application fee'.
Date
Name of the applicant : SAMARESH PAUL
Designation : Individual
(Proprietor/Partner/Managing
Director/Authorised Represntative):
Application on behalf of : Samaresh Paul
Address of applicant : Sonamura,Tamsabari, Sonamura, Sepahijala,
Tripura,SEPAHIJALA
PART - A:(GENERAL INFORMATION)
01. Full address of the proposed factory (mentioning Post Office, Police Station, urban
Local body/Panchayet with Ward No.etc.):
Telephone/Mobile
E-Mail
Police Station Sonamura.
Post Office Sonamura. Pin Code 799131
Urban Local Ward Number
Body/Panchayat
Subdivision SONAMURA District SIPAHIJALA
Mouza No.& Sheet No. Plot No. /Dag No.
02.Permanent Residential Address/Correspondence/of the owner
(Proprietor/Partner/Managing Director/Authorised Representative):
Mobile 9774150654
e-mail paulsamaresh02@gmail
.com
03. a)Size of Tiny
industry(Large/Medium/Small/Tiny):
b) Power Supply Agency at the factory Tripura State Electricity Corporation Ltd-
premises
[viz. Tripura State Electricity Corporation
Ltd/Others(specify)]
04. Proposed Date for Commissioning of October 2019
industry
05. (i)Number of person engaged by the factory :
a)Workers(including contact engagements): :0
b)Management Staff: :2
c)Others(Night watchman etc.): :
(ii)a)No. of working hours per day: :
b)No. of working day per year: :
06. Population residing in the :0
Quarters/Colony, if applicable:
07.Gross capital investment on land, building, plant & machinery excluding capital investment on
pollution control system of the unit till the date of application (In Lakhs)
Land: 0.0
Building : 0.3
Plant and Machinary: 2.78
Other: 0.0
Total Capital Investment: 3.08
(To be supported by an undertaking/affidavit/annual report or certificate from a Charted
Accountant)
08. Give the list of raw materials (including fuel) with consumption per month (if the space
provided below is found inadequate, please attach seprate sheet giving information using the
same format)
S.No. Name of Raw Material(including fuel) Quantity per Month Unit
-----------------NIL-----------------
09.List of products and by-products manufactured:
(if the space provided below is found inedequate, please attach separate sheet giving
information using the same format)
Product Name Production Average Unit
Capacity(per month) production(per month)
PART-B:INFORMATION REQUIRED IN CONNECTION WITH
PREVENTION AND CONTROL OF WATER POLLUTION
10.Water consumption for different uses
Type of Use Source of supply Quantity
(Strike out which is/are not (M3/day)
applicable))
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11.Information regarding liquid waste discharged
(Do not give information on storm water discharge)
Outlet No. Nature Sources (Place of Waste Place of discharge
(Industrial/Domestic/Mixed) Generation) Water
treatment
Facility
1 Industrial Municipal Drain yes MUNICIPAL
DRAIN
(if the space provided above is found inedequate, please attach separate sheet giving
information the same format
(Note:Please attach a diagram showing liquid waste flow from its place of generation
upto the of final discharge.)
12(a).Indicate available information on process waste water characteristics for PHYSICAL
(before treatment):
S.No. Parameter Expected Value
-----------------NIL-----------------
12(b).Indicate available information on process waste water characteristics for CHEMICAL
(before treatment):
S.No. Parameter Expected Value
-----------------NIL-----------------
[Please mention any other relevant parameter in space above]
[Attach additional sheet if necessary using the same format]
13.Attach latest 'analysis report' of the Board or Board's recognised laboratory showing quality
of liquid waste discharge(before and after treatment):
14(a).Proposed facility for liquid waste treatment for Industrial: Yes
14(b).Proposed facility for liquid waste treatment for Domestic: Yes
15.Whether water meter at water intake points installed: Yes
16.Whether energy meter of E.T.P. installed: Yes
17.Whether wate water flow measuring device installed: Yes
PART-C:INFORMATION REQUIRED IN CONNECTION WITH PREVENTION
AND CONTROL OF AIR POLLUTION
18.Details of source of emission
Sources of No. of Units Capacity of Fuel(Nature & Air Pollution Height of
Emission each Unit Quantity) Control stack from
Systems Ground Level
Provided
-----------------NIL-----------------
[Attach additional sheet if necessary using the same format]
19.Diesel Generator Sets
S.No. No. of DG Sets Capacity of Height Height of the Noise Pollution control
DG Set(in of the DG room(In measures
KVA) stack Meters)
above
DG
room(
In
Meter
s)
-----------------NIL-----------------
20.Emission details
Stac Stack Fuel Inner Height Flow Particul SO2 Others Description
k attache (Nature diameter(In from rate ate mg/Nm pollutan of air
No. d to &Quant meters) ground( Nm3/hr Matter 3 ts if any Pollution
ity) In mg/Nm control
meters) 3 devices, if
any
Top Bottom
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(If the space provided above is found inadequate, please attach separate sheet giving
information using the same format)(Attach latest 'analysis report' of the Board and Board's
recognised laboratory)
PART-D:OTHER INFORMATION
21.Give details regarding solid waste
Type of waste Description of Composi Qty./day Treatment and disposal
waste(Lump/Pa tion method
ste/Dust,etc.)
-----------------NIL-----------------
22.Attach a separate sheet(not applicable to small scale unit):
Providing a brief write-up and schematic flow sheet of the manufacturing process clearly
showing sources of generation of solid (hazardous and, non-hazardous)liquid and gaseous
wastes.
23.Attach layout plan clearly showing the different outlets for liquid waste discharge:
24.(a)Hazardous Chemicals to be handled [Refer-Manufacture, Storage and import of
Hazaradous Chemicals Rules, 1989(MSIHC)](Attach separate sheet if necessary)
S.No Names Daily Qty.
-----------------NIL-----------------
(b)Maximum quantity of Hazardous Chemicals to be stored at a time [Refer-Manufacture,
Storage and import of Hazardous Chemicals Rules, 1989(MSIHC)](Attach separate sheet if
necessary)
S.No Names Daily Qty.
-----------------NIL-----------------
25. Pollution Control Management
(a)Specify Environmental Management Plan including Monitoring
(b)Give brief organisational set up as per declaration given above
(c)Expenditure to be incurred for implementation of Environmental Management Plan(Capital
Investment)
26.Other relevant information, if any:(Please attach separate sheet if required)
Check-list of Accompaniments
1. photocopy of last years consent certificate (Attached)
