Hazardous Wastes (Management and Handling) Rules, 1989

FORM - 4
[See rule 9(2)]

Format for the submission of returns, regarding disposal of Hazardous Waste
(To be submitted to the State Pollution Control Board)

S: No

Date of issuance of authorization for the disposal of hazardous waste and its reference number (1)

Description of Hazardous Waste (2)

Physical form with description

Chemical form

Total volume of hazardous waste disposed with no. of packages

Mode of transport-

-ation to the site of
disposal (3)

Site of disposal (attach a sketch showing the locat

of disposal) (4)

Brief description of the method

disposal (5)


of dispo
-sal (6)

Remarks (if any)


3. Details of environmental survelliance :

Date of Measurement

Analysis of ground water (1)

Analysis of Soil samples (2)

Location of sampling

Depth of Sampling


Location of sampling

Analysis of Air samples (3)

Analysis of any other samples (4)


Location of sampling


(give details)

  Name and signature of the Head of the Facility


Find a Doctor