Medicine Section

FORM II (refer rule 10)

ANNUALREPORT
(To be submitted to the prescribed authority by 31 January every year)

1. Particulars of the applicant:
• Name of the authorised person (occupier/operator):
• Name of the institution:
• Address
• Tel. No
• Telex No.
• Fax No.
2. Categories of waste generated and quantity on a monthly average basis:
3. Brief details of the treatment facility:
• In case of off-site facility:
• Name of the operator
• Name and address of the facility:
• Tel. No., Telex No., Fax No.
4. Category-wise quantity of waste treated:
5. Mode of treatment with details:
6. Any other information:
7. Certified that the above report is for the period from
• Date ...............................
• Signature ...........................................
• Place.............................. Designation..........................................