Application Form Updated on: 13-02-2025

HARAYANA STATE POLLUTION CONTROL BOARD

C-11,SECTOR-6 PANCHKULA
Ph.2577870-73 Fax:01722581201-02

From: Industry ID-13HIS450711

M/s. Soft Care Surgical

Plot No. 95, Sec 27-28, Hisar
To

The Member Secretary,

Haryana State Pollution Control Board,
Panchkula.
Sir,
I/We hereby apply to consent/authorization for the year 31/01/2025 to 31/03/2035 Application
No. 92905949 dated 31-01-2025

1. Consent to /operate/renewal of consent under section 25 & 26 of the Water(Prevention and Control of
Pollution)Act,1974 as amended
2. Consent to /operate/renewal of consent under section 21 of the Air(Prevention and Control of
Pollution)Act,1981 as amended
3. Authorization/renewal of authorization under Rule 5 of the Hazardous Waste(Management and Handling
Rules)1999 as amended in connection with my/our existing/proposes/altered/additional
manufacturing/processing activities from the premises as per details given below:-

PART A: GENERAL

1. Name : Kapil Goyal

Designation : Auth Signatory
Office Address :
Telephone/Fax and : 98963-49423,-
Email Address of the applicant : [email protected]
2. (a) Name and location of the Industrial : Soft Care Surgical
Unit/Premises for which the application is Plot No. 95, Sec 27-28, Hisar
made.(Give Revenue Survey No/Plot 98963-49423
No.,name of the Tulaka and District,also -
Telephone No. and Fax No.)
(b) Details of Planning Permission obtained : NA
from Municipal Corporation /directories of
Urban Development of Town & Country
palnning/Haryana Urban Development
authority,whichever applicable.
(c) Name of Municipal Corporation/ : MC Hisar
Panchayat Samiti/Panchayat under whose
jurisdiction the unit is Located and name of
the license issuing Authority.
3. Name
Address
Telephone No.,Fax and
E-mail address
of the officer responsible for the matter connected with Pollution Control and Hazardous Waste Disposal.
S.No. Name Designation Residential Email Id Mobile Owner Type
Address Number
-----------------NIL-----------------
4. If registered as a small-scale industrial : , 01/01/2014
unit,give Number and Date of registraion.
5. Gross Capital Investment of the unit without : 39.5
depreciation till the date of application(cost
of building,land,plant and machinery)(to be
supported by affidavit,annual report and
certificate from Chartered Accountant.For
proposed units, give estimated figure(In
Lakhs)).
6. If the site is located near river bank/other water bodies; indicate the name and distance of the water body.
Sr. No. Surrounding of site Distance(in meters) Description
-----------------NIL-----------------
7. Does the location satisfy the requirements :
under relevant Central/State Government
notifications on ecologically fragile area
etc., if so give details.
8. If the site is situated in notified industrial :
estate:

(a) Whether effluent collection,treatment

and disposal system has been provided by NO
the authority;
NO
(b) will the applicant utilize the system,if
provided; ETP Installed

(c) if not provided, details of proposed

arrangement for the treatment of effluent.
9. Total Plot Area,Built up Area and Area : Total Plot Area : 1000
available for the use of treated sewage/trade Built-up Area : 400
effluent.
10. Month and year of proposed commissioning : 01/04/2014
of the unit.
11. Number of workers and office staff. : 10
12. (a) Do you have a residential colony within :
the Premises in respect of which the present YES
application is made?
2
(b)If yes,please state population staying

(c)indicates its location and distance with

reference to plant site.
13. List of products and by-products manufactured in tones/Month,Kiloletre/Month or Numbers/Month(give
figures corresponding to maximum installed production capacity).
 Sr. Name of the Product Quantity of Products produced/to be produced.
No. produced/to be produced
Licensed Installed Avg. Actual Average
production Production Production Actual
capacity Capacity production for
which the
consent is
sought
1 surgical Kg/Day 400 400 270 270
cotton

Sr. Name of the By-Products Quantity of By-Products produced/to be produced.

No. produced/to be produced
Licensed Installed Avg. Actual Average
production Production Production Actual
capacity Capacity production for
which the
consent is
sought
1 NA Numbers/D 0 0 0 0
ay
14. List of raw-material and process of Chemicals with Annual consumption corresponding to above stated
Production Figures, in tones/month or numbers/month.
S.No. Name of the Raw- Quantity of the Raw- Unit
material/Chemicals used/to material/Chemicals
be used used/being used
1 waste cotton 300 Kg/Day
15. Description of Process of manufacture for : Ind. Area
each products showing input/output, quality
and quantity of solid, liquid and gaseous
wastes,if any, forms each unit process.(to be
supported by flow sheet and material
balance).

PART B: WASTE WATER ASPECTS (FOR WATER OF CONSENT) IF NOT APPLICABLE, WRITE
NOT APPLICABLE.

16. Water consumption for different uses (m3/day).

Sr. No. Water Consumed For Quantity(KLD)
1 Process and wash 4.0
2 Sanitation/Domestic/Horticulture 1.0
17. Source of water supply, Name of authority granting permission if applicable and quality permitted.
Sr. Source Type Source Name Quantity (KLD)
No.
1 Ground Water (outside water tankers 5.0
premises)
18. Water Treatment Details :
 Sr. Use Effluent Treatment Treatment Details
No. Generation(KLD) Arrangement Status

1 Trade Effluent 4.0 Yes ETP

2 Domestic Effluent 1.0 Not Required Sewer
19. Waste Water Discharge/Dosposal Details :
S.No Type of Effluent Maximum Effluent to be Effluent Mode of disposal
Generation Recycle(KLD) Disposal/Discharg
Quantity of e Quantity (KLD)
Effluent(KLD)
1 Trade Effluent 4.0 0.0 4.0 Public Sewer
2 Domestic 1.0 0.0 1.0 Public Sewer
Effluent

20. Quality of untreated/treated effluents(specify pH and concentration of suspended solids, Bio

chemical,Oxygen Demand and specific pollutants relevant to the industry.Total dissolved solids to be
eported for disposal on the land or into stream/river).
Enclose a copy of latest report of analysis from the laboratory approved/ recognized by Haryana State
Pollution Control Board/Central Government in the Ministry of Environment and Forest. For proposed unit
furnish expected characteristics of untreated/treated effluents.
Sr Type of Paramete Conc. of Pollutant Unit Date of report Report Name of
. Effluent rs analysis Laborato
N no. ry
o.
Untreated Treated
-----------------NIL-----------------

PART C: AIR EMISSION ASPECTS(FOR AIR CONSENT) IF NOT APPLICABLE, WRITE NOT
APPLICABLE.

21. Fuel Consumption :

Fuel Daily Unit Calorific Ash Sulphur Others

Name Comsumptio value contents contents
n(T/day)
WOOD 200 Kg/Day 0 0 0 0
22. Details of Stack
 Stacks Numbers : 1
Stack Attached to: Chimney ,
Fuel type: wood ,
Fuel Quantity: 200 ,
Material for MS ,
construction of Stack:
Shape Round ,
(Round/Rectangle):
Height above ground 15 ,
level(in metres):
Diameters/Size in 1,
meters
Gas quantity Nm^3/hr: 0,
Gas Temperature 'C: 0,
Exit velocity of 0,
Tones/sec:
Details of DG Set:
Sr. Capacity of D.G. set Quantity of Fuel Ht. of Stack Whether
No. in(KVA) used/to be used (in provided/to be canopy/acoustic
Lts./day) provided above roof enclosure provided/ to
level(in mts.) be provided(please
define clearly)
1 25 10 3 Yes
23. Do you have an adequate facility of : YES
collection of samples of emission in the
form of portholes, platforms, ladder etc., as
per Central Board Publication 'Emissions
Part iii'(December1985).
24. Quality of treated fuel gas emission and process emissions. Specify concentration of criteria pollutants and
industry/process specific pollutants stack wise.
Enclose a copy of latest report of analysis from the approved/ recognized laboratory by Haryana State
Pollution Control Board/ Central Government in the Ministry of Environment and Forest. For proposed
units, furnish the expected characteristics for the emission.
Fuel Gas Emission quality parameter details:
Sr. Stack Parameters Result Units
No.
-----------------NIL-----------------

Process Emission quality parameter details:

Sr. Process Parameters Conc. of pollutants Units
No
.
Untreated Treated
-----------------NIL-----------------
Details of Process Emission:
 Sr. No. Source of Name of the Details of Height of Stack provided/to Whether
Generation emissions(i.e APCD be provided for discharge of emission
of process SO2/NOx/Aci provided/to process emissions(in mts).. sampling
Emissions d Mist/any be provided facilities
other). to control provided or
process not
emissions.
Above Above Roof
Ground Level
Level
1 Chimney Other [Multi 15 10 Yes
Cyclone
Separator]

PART E: ADDITIONAL INFORMATION

28. (a) Do you have any proposals to upgrade : YES

the present system for treatment and
disposal of effluent/emission and hazardous
waste.
(b) If yes,give details with time-schedule for
the implementation and approx. expenditure
to be incurred on it.
29. Capital and Recurring (Operations and : NA
Maintenance) expenditure on the various
aspects of environment protection such as
effluent emission HW solid waste tree
plantation monitoring data acquisition etc.
30. To which the pollution Control equipment : NA
separate meters for recording consumption
of electric energy are installed?
31. Which of the pollution Control items are : NA
connected to Diesel Generator set (captive
power source) to ensure the running in the
event of normal power failure.
32. Name, quantity and method of disposal non- : NA
hazardous solid waste generated separately
from the process of manufacture and waste
treatment(give details of area/ capacity
available in applicants land).
33. Hazardous chemicals are defined under the :
Manufacture, Storage and Import of
Hazardous Chemicals, Rules 1989.
(a) List of Hazardous Chemicals NA
stores(imported and indigenous).

(b) Details of isolated storage. NA

(c) Details of emergency preparedness plans NA

(On-Site/ Off-Site prepared).
34. Brief details of tree plantation/ green belt : NA
development within applicant's premises.
35. Information of schemes for waste : NA
minimization, source recovery and recycling
implemented and to be implemented,
separately.
36. Any other additional information that the : NA
applicant desires to give.
37. I/We furthur declares that the information furnished above is correct to the best of my/our knowledge.
 38. I/We hereby submit that I am the authorised person of this unit to apply for CTO and incase of any change
from what is stated in this application in respect of raw-materials, products, process of manufacture &
treatment and/or disposal of emissions, hazardous waste etc. in quality & quantity; a fresh application for
consent/authorization shall be made & until the grant of fresh consent/ authorization, no change shall be
made.
39. I/We undertakes to furnish any other information within 1 month of its being called by the
Board/Committee.
40. I/We agreed to submit to the board an application for renewal of consent/autorization 3 months in advance
before the date of expiry of the consent/authorization validity period.
41. I/We deposit Rs..........(.....rupees) in favour of Haryana State Pollution Control Board as the fee for Consent/
Authorization.
Sr. Fee For Bank Name Branch DD Date Amount(in
No. No./Cheque Rs.)
No.
42. Declaration about awareness of the prescribed standards :-
a.) That I am aware of the provisions of the Water Act, 1974, Air Yours faithfully,
Act, 1981 & Hazaradous Waste Management Rules,2008 and
standards/norms prescribed for discharge of pollutants under EPA Signature______________
Rules, 1986. Name Kapil Goyal
Designation Auth Signatory
b.) That we shall comply with all the provisions of Water Act, 1974,
Air Act, 1981 & Hazaradous Waste Management Rules, 2008 and
standards/norms prescribed for discharge of pollutants under EPA
Rules, 1986 after commissioning of our unit.

c.) That the work for construction and installation of pollution control
measures will be done side by side while doing the construction and
installation of the main plant of the unit and will not start the
production with out installing proper and adequate pollution control
measure as per scheme enclosed and without obtaining prior consent to
operate from the Board.

d. In Case of any of the non-compilance by the unit, the Board will be

at liberty to forfeit the performance security deposited along with the
security case.

DOCUMENTS ENCLOSED:

1. Any other document 1

2. Environment Statement of the previous year for large and medium scale Industries / Projects.
3. Any other document 2
4. C.A. Certificate regarding capital investment cost w.r.t. land building, plant and machinery of the proposed
project.
5. Detail of Effluent Treatment Plant / Sewage treatment Plant, Air Pollution Control Devices / HWM, as
applicable.

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