Form - IV(See rule 13)
ANNUAL REPORT[To be submitted to the prescribed authority on or before 30 th June every year for the period from January
to December of the preceding year, by the occupier of health care facility (HCF) or common bio-medical
waste treatment facility (CBWTF)]
Application Type: Industry
1) Particularsi) First Name
SURENDRAKUMARii) Middle Name
KORANiii) Last NamePONNANPARAMBILiv) Designation
OCCUPIER & SITE MANAGERv) Aadhaar No
982004023032vi) PAN No
AFGPP0479Kvii) Address as per Aadhaar CardPRIDE PLATINUM, F.NO. G-802, BANER, NEARPANCARD CLUB, BANER, PUNE - 45viii) Tel. No.
0202710473ix) Fax No.
02027145339x) e-mailp.surendrakumar@sandvik.comxi) URL of website
www.sandvik.com

2) Address for Correspondencei) Building Name/Building No./Survey
NumberCTS NO. 2223, 2223/1ii) Street / Village
Old Mumbai-Pune Roadiii) City / Taluka
Haveliiv) District
Punev) Pin-Code Number
411012vi) Near by Landmark
Near Sai Service Stationi) Building Name/Building No./Survey
NumberCTS NO. 2223, 2223/1ii) Street / Village
Old Mumbai-Pune Roadiii) City / TalukaHaveliiv) DistrictPunev) Pin-Code Number411012vi) Near by Landmark
Near Sai Service Stationvii) Latitude coordinate of Industry
18.592971

viii) Longitude coordinate ofIndustry
73.830158

ix) Ownership of Industry
Private3) Name of Industry
SANDVIK
4) Address of Industry

5) Status of Authorisation under the Bio-Medical Waste (Management and Handling) Rulesi)Authorization No.
SRO-PIMPRICHINCHWAD/BMW_AUTH/1703000296

ii)Authorization validity Date
2020-03-31

6) Status of Consents under Water Act andAir ActYesi)Consent Number
BO/CAC-Cell/UAN NO.
PN-40000041418-18/3rdCAC-1811000104ii)Consent validity Date
2023-03-317) Type of Health Care Facility
Non-bedded hospitali) No of Beds
28) Registration Number (e.g. Bombay Nursing Home reg. no.,MSDC,MBTC)
PCMC-A-189) Registration Expiry Date
2020-03-3110) Faculty of Medicine711) Name of the Common Bio-Medical Waste Treatment Facility Operator through which wastes are disposed ofM/s. Passco Environmental Solution, PCMC
12) Details of BMW Generatedi) Authorized BMW Quantity MT/anum (as per valid CCA)

Yellow 0.00960

Red 0.00080

BlueWhite 0.00020

BlueWhite 0.00100ii) Generation of BMW Quantity (kg/day)Yellow 0.02600

Red 0.00200iii) BMW disposed at CBMWTSDF(kg/day)Yellow 0.03

Red 0.00

BlueWhite 0.00

General Solid Wasteiv) Quantity of waste generated and disposed in MT/annum (on monthly average basis)

Yellow 0.00

Red 0.00

BlueWhite 0.00

13) Do you have bio-medical waste management committee? If yes, attach minutes of the meetings held during thereporting periodNo14) Details trainings conducted on BMWi) Number of trainings conducted on BMW Management.
20ii) Number of personnel trained
700iii) Number of personnel trained at the time of inductioniv) number of personnel not undergone any training so farv) whether standard manual for training is available?
Novi) any other information
NIL15)Details of the accident occurred during the year(i) Number of Accidents occurred(ii) Number of the persons aﬀected(iii) Remedial Action taken (Please attach details if any)
No(iv) Any Fatality occurred, If yes details.
No16) Are you meeting the standards of air Pollution from the incinerator? How many times in last year could not met the standards?

(i) Details of Continuous online emission monitoring systems installedNo17) Liquid waste generated and treatment methods in place. How many times you have not met the standards in a year?
No18) Is the disinfection method or sterilization meeting the log 4 standards? How many times you have not met thestandards in a year?
Yes,19) Any air pollution control devices attached with the Incinerator NoPlaceDAPODI, PUNE - 411012

Designation
MEDICAL OFFICER

Date
2020-01-08