Proforma For Affidavit (Duly Signed by Deponent & Attested by Notary Public)

I. .. . . . . . . .. . . .. . . . . . . ... .. . ... ... . . . . .. ... ... ... .S/o Shri... ... . .. ... ... .. ... ... .. . ... . . . R/O... ... ... ... ... ... ... .. . ... ... .. . . . Do solemnly affirm and declare as under:1. That I am .(Proprietor/Partner/Director) in the unit named M/s(name &address of the unit) and authorized & responsible for operation of the aforementioned unit & for compliance of the Hazardous Waste (Management and Handling) Rules, 1999 as amended to date. 2. That status of the aforementioned unit is as given below: a) Products manufactured in the unit are (with Quantity in Metric Tones per Annum) (i). (ii).................................... (iii).............................. b) Production capacity of the unit is... ... ... ... ... ... ... ... Kg per day and... ... ... .. ..Kg per annum c) Activities involved in the process are... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..... ... ..... ... ..... d) Hazardous Waste (HW) generating Processes, as per Schedule I are... . . . . . . . .. ... . . . . . . . . . . . . ... e) Hazardous Waste generating streams (i) as per Schedule 1.......................................... (ii) as per Schedule 2...... f) Quantity of Hazardous Waste generation as per Schedule I i) ... ... ... ... ... ... Kg/day &... ... ..MT/ Annum (Type of Hazardous Waste) (ii)... ...Kg/day &.MT/Annum (Type of Hazardous Waste) g) Quantity of Hazardous Waste generation as per Schedule 2 (i)........... ... ... ... Kg/day & ... ............ ..MT/Annum (Type of Hazardous Waste) (ii)... ... ... ... ... ... Kg/day &... ... ... ................MT/ Annum (Type of Hazardous Waste) h) Total Quantity of Hazardous Waste Generation in Metric Tones per Annum (MT A): (f+g) is . i) Quantity of Hazardous Wastes ( in MT A) : j) (i) Disposal in Landfills............... .(ii) Recyclable ........... .(iii) Incinerable ................. k) Quantity of used oil/Waste Oil generation is... ... ... ... ... ... ... .KG/day & ... ... ... ... ... KG/Annum l) Total quantity of hazardous waste stored at site of the unit ( as on 31.03.2006 ) is ... . . . . . . . .. . . . . Kg. m) Quantity of hazardous waste generated during the period from 1.4.2005 to 31.03.2006 isKg. n) Status of consent under Air & Water Act: (i ) Consent order No :... ... ... ... ... ... ... ... ... .. (ii) Consent Valid up to :... ... ... ... ... . (iii )Last applied on ... ... ... ... ... .vide ID. No... ... ... ... ...... 3. That Hazardous Waste is stored in leak proof container (s) and able to drain/ remove liquids, and the containers are duly marked with Hazardous Waste" in red colour and with date, of beginning of storage on each containers. 4. That Hazardous Waste containers are stored on pucca floor in an isolated covered area in the unit in such a manner that it does not in any way contaminate the environment on the ground water due to air/rain/seepage/leakage etc. 5. That storage facility is having appropriate containment system. I have taken precautions to prevent any accidental ignition or recation of ignitable or reactive sate. 6. The duly filled display boards ( two no. of 6 ft x 4 ft. each) as prescribed by Local Area Environment Committee for Delhi and as referred in the Public Notice issued by DPCC on 20.11.2005 are ,displayed outside the main gate of the unit. That record of Hazardous Waste Generation is being maintained in Fonn-3 as prescribed in HW Rules since. That Annual returns for Hazardous Waste has been filed in DPCC in prescribed Fonn-4. That I have taken steps which were feasible for reduction and prevention in the waste generated and also taken steps for recycling /reuse of hazardous waste and steps taken are stated below (i) ... ... ... ... ... ... ... ... (i i ) ... . . . .. . .. . . .. .. . . .. .. . .. ... ( iii ) ... ... ... ... . .. ... ... .. . .. . .. ... ...

7. 8. 9.

10. That I have complied with the terms and conditions of the authorization granted under the Hazardous Wastes (management & Handling) Rules, 1989 as amended to date. 11. That I have complied with the provisions of the Environment (Protection) Act, 1986 and Rules made thereunder including the Hazardous Waste (Management & Handling) Rules, 1989 as amended to date.

DEPONENT VERIFICATION Verified on this... ... ... ... ... .. ..Day of............. ... ..... ... ... .(month ), 2006 that the above contents of the affidavit are true and correct to the best of my knowledge and belief and nothing has been concealed thereform. DEPONENT