This consignment is made in accordance with the Hazardous Waste Regulations 2005 and/or Environmental Protection (Duty of Care) Regulations 1991 (as amended). Customer site number:
info@albusenvironmental.com
PART A
1. Consignment note code /
2. The waste below is to be removed from —
3. The waste is to be taken to
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 — complete the information below for each EWC identified
Description of waste EWC code Quantity (kg) Component Concentration Physical form Hazard codes Bag (5H4) Sharps box (3H2) Sealed unit (3H2) Wheeled cart (50H)
Information completed for EWC codes 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 a schedule of carriers is attached. I certify that I today collected the consignment and that the details in A2, A4 and B4 are correct. I have been advised of any specific handling requirements.

Collection number:

  1. Carrier's name (print):
    On behalf of: Albus Environmental Ltd, Unit 2 Oakwood Yard, Watling Street, Dartford DA2 8AH
  2. Carrier registration no: CBDU48101
  3. Vehicle registration no:
Signature:

Date:   Time:

PART D

I certify that the information in A, B and C above is 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 the 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:   Time: