| CHEMICAL RECOVERIES,
BS11 0YA |
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Boxes in Grey for Chemical
Recoveries Use Only |
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| Waste
Acceptance Form |
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CRWAF Number |
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| About
the Waste Producer |
Items marked * are required to
process this form |
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| Producer
Company Name or Site Location * |
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CRIBS No for Producer |
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| Producer
Address Line 1 * |
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| Producer
Address Line 2 |
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| Producer
Address Line 3 |
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| Producer
Town * |
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| Producer
County |
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| Producer
Postcode * |
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| About
the Waste |
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| This form and CRWAC number is unique for each
individual waste stream and thus required for every waste
stream from a producer |
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| Waste
Description * |
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| EWC
Code (six digits only) * |
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| If EWC Code has an asterisk and is a
mirror entry we will assume it is hazardous unless "NON HAZ" is added above (eg
190201* NON HAZ) |
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| Physical
State (gas,liquid.solid, sludge, mixed) * |
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* Required if waste is hazardous |
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| Container
Type/ Size and Number for each consignment |
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| Estimated
Annual Quantity - this must be in kgs - (conversion formula up to producer if
exact kgs not known) |
kilogrammes |
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| Hazard
Codes (eg H3-A, H6 etc) * |
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| Producer EA Premises
Code * and expiry date |
expires on: / / |
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| Producer
Contact (full name) * |
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| Process
giving rise to the waste |
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| Producer Contact (email) |
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| note: we are required under Haz Waste Regs
2005 to send a form or copy of consignment note for every HAZ load we receive
to the producer |
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| and will send that information to the
contact above, preferably by email. If your require additional copies as a
borker complete last box on form |
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| Items
below are optional for this form but are required under Carriage Regulations
and on Consignment Notes for Hazardous Loads |
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| if
non-haz for carriage then complete box as "NON HAZ" |
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| UN
identification number |
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| Proper
Shipping Name |
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| UN
Class(es) |
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| Special
Handling Requirements |
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| Complete
the Form |
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| Name of
Person completing form |
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| Company
Name if Different from Producer (Broker) |
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CRIBS No for Broker |
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| Broker
Address Town (if applic) |
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| Broker
Address Postcode (if applic) |
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| Signature |
completed on: / / |
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| If you
are a Waste Broker and/or wish to receive copies of the Returns for this
producer include an email address or email addresses |
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