Information
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Document No.
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Client / Contract
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Date of disposal
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Name:
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Waste Carriers Licence
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What is your waste carriers licence number?
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Desription of waste (select all that apply)
- Brick, concrete, tiles or ceramics (17 01 07)
- Wood and Timber (17 02 01)
- Sawdust shavings and chipboard (03 01 05)
- Glass (17 02 02)
- Plastic (17 02 03)
- WEEE Waste (16 02)
- Scrap Metal (20 01 41)
- Electrical Cables (17 04 11)
- Packaging (15 01)
- Textiles and dust Sheets (20 01 11)
- Furniture, appliances, etc (20 03 07)
- Insulation (17 06 04)
- Biodegradable garden waste (20 02 01)
- Paint Cans (15 01 04)
- General Waste (20 03 01)
- Other
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Please describe what the other type of waste is:
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How much waste are you disposing of? (please select option)
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Please give waste amount (remember to include units if applicable)
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Where has this waste been transferred to for disposal?
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Please take a clear photo of any waste transfer notes you have received from the waste transfer station
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Declaration: By submitting this electronic waste transfer note, all parties confirm they have fulfilled their duty to apply the waste hierarchy as required by Regulation 12 of the Waste (England and Wales) Regulations 2011. In addition, all parties confirm that the required checks have been completed and the waste is being passed to an authorised person. This information will be stored for a minimum of 3 years from completion.
SIC Code (2007): 41:20/2 -
Signature
