Form Hwcn01V051 – Fill Out and Use This PDF

The Hazardous Waste Regulations 2005:

Consignment Note

PRODUCER’S/HOLDER’S/CONSIGNOR’S COPY (Delete as appropriate)

PART A Notification details

1

Consignment note code:

/

4 The waste will be taken to (name, address and postcode):

2

The waste described below is to be removed from (name, address,

postcode, telephone, e-mail, facsimile):

5 The waste producer was (if different from 2) (name, address,

postcode, telephone, e-mail, facsimile):

3

Premises code (where applicable):

PART B Description of the waste

If continuation sheet used, tick here ■

1

The process giving rise to the waste(s) was:

2 SIC for the process giving rise to the waste:

.

/

EWC code

Packing group(s)

UN identification

Proper shipping name(s)

UN class(es)

Special handling

number(s)

requirements

PART

C

Carrier’s

certificate

PART D Consignor’s certificate

(If more than one carrier is used, please attach schedule for subsequent

I certify that the information in A, B and C above is correct, that the carrier

carriers. If a schedule of carriers is attached tick here. ■ )

is registered or exempt and was advised of the appropriate precautionary

I certify that I today collected the consignment and that the details in A2,

measures. All of the waste is packaged and labelled correctly and the carrier

has been advised of any special handling requirements.

A4 and B3 are correct and I have been advised of any specific handling

requirements.

1 Carrier name:

1 Consignor name:

On behalf of (name, address, postcode, telephone, e-mail, facsimile):

On behalf of (name, address, postcode, telephone, e-mail, facsimile):

Signature

Signature

Date

D

D

M

M

Y

Y

Y

Y

Time

H

H

M

M

Date

D

D

M

M

Y

Y

Y

Y

Time

H

H

M

M

PART E Consignee’s certificate (where more than one waste type is collected all of the information

given below must be completed for each EWC)

Individual EWC

Quantity of each EWC code received (kg)

EWC code

Waste management operation (R or D code)

code(s) received

accepted/rejected

1

I received this waste at the address given in A4 on:

Date

D

D

M

M

Y

Y

Y

Y

Time

H

H

M

M

2

Vehicle registration no. (or mode of transport if not road):

Name:

On behalf of (name, address, postcode, telephone, e-mail, facsimile):

3

Where waste is rejected please provide details:

The Hazardous Waste Regulations 2005:

Consignment Note

CARRIER’S COPY

PART A Notification details

1

Consignment note code:

/

4 The waste will be taken to (name, address and postcode):

2

The waste described below is to be removed from (name, address,

postcode, telephone, e-mail, facsimile):

5 The waste producer was (if different from 2) (name, address,

postcode, telephone, e-mail, facsimile):

3

Premises code (where applicable):

PART B Description of the waste

If continuation sheet used, tick here ■

1

The process giving rise to the waste(s) was:

2 SIC for the process giving rise to the waste:

.

/

EWC code

Packing group(s)

UN identification

Proper shipping name(s)

UN class(es)

Special handling

number(s)

requirements

PART

C

Carrier’s

certificate

PART D Consignor’s certificate

(If more than one carrier is used, please attach schedule for subsequent

I certify that the information in A, B and C above is correct, that the carrier

carriers. If a schedule of carriers is attached tick here. ■ )

is registered or exempt and was advised of the appropriate precautionary

I certify that I today collected the consignment and that the details in A2,

measures. All of the waste is packaged and labelled correctly and the carrier

has been advised of any special handling requirements.

A4 and B3 are correct and I have been advised of any specific handling

requirements.

1 Carrier name:

1 Consignor name:

On behalf of (name, address, postcode, telephone, e-mail, facsimile):

On behalf of (name, address, postcode, telephone, e-mail, facsimile):

Signature

Signature

Date

D

D

M

M

Y

Y

Y

Y

Time

H

H

M

M

Date

D

D

M

M

Y

Y

Y

Y

Time

H

H

M

M

PART E Consignee’s certificate (where more than one waste type is collected all of the information

given below must be completed for each EWC)

Individual EWC

Quantity of each EWC code received (kg)

EWC code

Waste management operation (R or D code)

code(s) received

accepted/rejected

1

I received this waste at the address given in A4 on:

Date

D

D

M

M

Y

Y

Y

Y

Time

H

H

M

M

2

Vehicle registration no. (or mode of transport if not road):

Name:

On behalf of (name, address, postcode, telephone, e-mail, facsimile):

3

Where waste is rejected please provide details:

The Hazardous Waste Regulations 2005:

Consignment Note

CONSIGNEE’S COPY

PART A Notification details

1

Consignment note code:

/

4 The waste will be taken to (name, address and postcode):

2

The waste described below is to be removed from (name, address,

postcode, telephone, e-mail, facsimile):

5 The waste producer was (if different from 2) (name, address,

postcode, telephone, e-mail, facsimile):

3

Premises code (where applicable):

PART B Description of the waste

If continuation sheet used, tick here ■

1

The process giving rise to the waste(s) was:

2 SIC for the process giving rise to the waste:

.

/

EWC code

Packing group(s)

UN identification

Proper shipping name(s)

UN class(es)

Special handling

number(s)

requirements

PART

C

Carrier’s

certificate

PART D Consignor’s certificate

(If more than one carrier is used, please attach schedule for subsequent

I certify that the information in A, B and C above is correct, that the carrier

carriers. If a schedule of carriers is attached tick here. ■ )

is registered or exempt and was advised of the appropriate precautionary

I certify that I today collected the consignment and that the details in A2,

measures. All of the waste is packaged and labelled correctly and the carrier

has been advised of any special handling requirements.

A4 and B3 are correct and I have been advised of any specific handling

requirements.

1 Carrier name:

1 Consignor name:

On behalf of (name, address, postcode, telephone, e-mail, facsimile):

On behalf of (name, address, postcode, telephone, e-mail, facsimile):

Signature

Signature

Date

D

D

M

M

Y

Y

Y

Y

Time

H

H

M

M

Date

D

D

M

M

Y

Y

Y

Y

Time

H

H

M

M

PART E Consignee’s certificate (where more than one waste type is collected all of the information

given below must be completed for each EWC)

Individual EWC

Quantity of each EWC code received (kg)

EWC code

Waste management operation (R or D code)

code(s) received

accepted/rejected

1

I received this waste at the address given in A4 on:

Date

D

D

M

M

Y

Y

Y

Y

Time

H

H

M

M

2

Vehicle registration no. (or mode of transport if not road):

Name:

On behalf of (name, address, postcode, telephone, e-mail, facsimile):

3

Where waste is rejected please provide details: