Amendment status not verified — confirm the current text below against the official source.
Processing fee for License Rs. (As prescribed by Delhi Jal Board) D.D. No._____________Date_____________Bank____________________ I/We certify that information given by me/us in column 1 to 11 are true to the best of my knowledge and belief. I also certify that I have read and understood the attached terms and conditions 1 to 13 and agree to abide by them. I agree that if any information given by me is found wrong the application for License will be liable for cancellation at any time. Signature(s) of applicant(s) Date: __________________ No. of document attached: _______________ PASTE PHOTO (SELF ATTESTED) 24 DELHI GAZETTE : EXTRAORDINARY PART IV] ANNEXURE-(3) (See Regulation –12-B) COLLECTION AND TRANSPORT RECORDS FORM Sample Form to be filled by Licensee i. Identification of Waste: a) Volume b) Type:__________ Septic Tank______________Others c) Address ii. Details of Waste Generator: a) Name b) Phone Number c) Address d) Pin The undersigned being duly authorized does hereby certify the accuracy of the source and type of wastewater collected and transported Date___________________Signature (of the generator/owner/occupier) iii. Details of Transporter/Operator: a) Company Name b) Permit No. c) Vehicle License d) Pump out date The above described wastewater was collected and disposed by me to the disposal facility name below and was discharged. I certify that the foregoing is true and correct. e) Signature of authorized agent and title:____________________________ iv. Acceptance by__________________DJB’s authorized SPS/STP The above transporter delivered the described Septage to this disposal facility and it was accepted. Disposal Date_______________Amount Collected from Transporter________ Signature of authorized signatory and title___________________________ NOTE: SUBJECT TO THE TERMS AND CONDITIONS OF DELHI WATER BOARD SEPTIC TANKWASTE MANAGEMENT REGULATIONS 2018 AND ORDERS/GUIDELINES ISSUED BY THE BOARD UNDER THESE REGULATIONS FROM TIME TO TIME. TERMS AND CONDITIONS