Wastewater from NephroPlus facilities are primarily from dialysis units, water purification plants and miscellaneous housekeeping activities in addition to limited quantities of sanitary wastewater from toilets and washrooms. Wastewater is discharged to public sewers in compliance with local municipal regulatory requirements. Where no public sewerage system is available, wastewater is pretreated to regulatory acceptable standards prior to discharge. Sources of air emission from NephroPlus facilities include those from standby diesel generators for contingency power and discharge from HVAC systems. Monitoring of air emissions varies by location, but complies with applicable local regulatory requirements.
	
Handling and disposal of medical materials and bio-hazardous wastes at NephroPlus facilities comply with national and local regulatory requirements. Infectious and pathological wastes, sharps and sharps containers are stored in adequately secured storage areas before they are collected for treatment and disposal by licensed vendors. Procedures and mechanisms are in place to provide for separate collection and alternate disposal of excreta and body fluids containing prescribed drugs, antibiotics, etc. Ultimate disposal of these wastes varies by location, and typically includes incineration or landfill in approved facilities. NephroPlus does not own or operate any incineration facilities, and relies solely on government licensed waste processing facilities for disposal of its infectious, pathological and related hazardous wastes. NephroPlus facilities do not produce any radioactive waste. 
	
Annual fresh water consumption by NephroPlus facilities is estimated to be about 56,000 cubic meters which is either supplied by the local municipal corporation or from groundwater wells, depending on availability and location. Water is treated at each of the standalone facilities to usable grade for dialysis prior to use. Where NephroPlus facilities are collocated within hospitals, water is provided by the hospital. Annual energy consumption will include 3,000 liters of diesel and 780,000 of electricity. Net greenhouse gas (GHG) emissions attributable to NephroPlus annual consumption of electricity and fuel, is estimated to be about 700 metric tons of carbon dioxide equivalents per year.