This consignment is made in accordance with the: Hazardous Waste Regulations 2005 and/or Environmental Protection (Duty of Care) Regulations 1991 (as amended)

PART A





PART B
1. The process giving rise to the waste was: 2. SIC for the process giving rise to the waste:
SIC 2007:
3. Waste Details where more than one waste type is collected all the information given below must be completed for each EWC identified
Description of the waste List of Waste (EWC code) Quantity (kg) The chemical/biological components of the waste and their concentrations: Physical Form Hazard Codes Container type, number and size
Component Concentration Bag (5H4) Sharps Box (3H2) Sealed Unit (3H2) Wheeled Cart (50H)
The information below is to completed for EWC code identified
EWC Code Number(s) Proper shipping name(s) UN Class(es) Packing Group(s) Special Handling Requirements
PART C
Tick if more than one carrier is used and schedule of carriers is attached. I certify that I today collected the Consignment and that the details in A2, A4 and B4 are correct and I have been advised of any specific handling Requirements. where this note comprises part of a multiple collection the round no and

collection no are :

  1. Carrier’s Name (PRINT):
    On behalf of: Albus Environmental Ltd, Unit 2 Oakwood Yard, Watling, Dartford DA2 8AH
  2. Carrier Reg. No: CBDU48101
  3. Vehicle Reg. No:

Signature:


Date: 09/01/26    Time: 16:26

PART D
I certify that the information in A, B and C above are correct, that the carrier is registered or exempt and was advised of the appropriate precautionary measures. All of the waste is packaged and labelled correctly and the carrier has been advised of any image duty to apply the waste hierarchy as required by regulation 12 of the Waste (England and Wales) Regulations 2011.
Consignor Name (PRINT):

on behalf of:



Signature:


Date: 09/01/26    Time: 16:26