ENV02 WASTE CONSIGNMENT NOTE (Rev 2 Aug 18)

Part A : note details

• Waste Code

  BOOKER

  MAKROS

  BPOILU

  FOURSE

  HOUSEO

• A1 : Waste Note Code ( this will be job number )

• A2: The waste described is to be removed from :

Details

• Client name

• Site ID number

• Address
  Address

• Phone number .

A3: The waste will be taken to:

• Company.

• Address
  Address

A4 : Waste producers details : City FM Ltd , Calidonia House , Lawmoor Street , Glasgow , G50US . Tel : 01414189000 / Email : cityfm.info@city-holdings.co.uk

Part B Description of waste 1. The process giving rise to the waste(s) was: facilities management activities (lamps changing and refrigerant gas changes) 2. SIC for the process giving rise to the waste : a) 33140 (repair of electrical equipment) b) 33190 (repair of other equipment)

• Description of waste

description

• Select SIC code

  33140. ( repair of electrical equipment)

  33190 ( repair of other equipment)

• Select waste type

  Electrical

  Refrigerant

  Other

• Other please specify

• Select electrical waste

  Select Fluorescent lamps 200121 ( Mercury, phosphor ) ( Concentration <1% ) ( HP6 & HP14 Hazards ) Sodium lamps 160213 ( Mercury , Sodium ) ( Concentration <1% ) ( HP6 & HP16 Hazards ) Mixed construction & Demolition waste 170904 Lead acid batteries 160601 ( Sulphuric Acid , Lead ) ( Concentration <1% ) ( HP3a,HP6,HP14,HP5,R35,HP8 Hazards ) NICad batteries 160211 ( Nickel Cadmuium ) ( concentration <1% ) ( HP3A,HP6,HP14,HP5,HP8,R35 Hazards ) Electrical Equipment (Hazardous) 160211 ( containing Chiofluorocarbon HCFC , HFC ) ( concentration <1%) ( HP14 hazard )

  • Fluorescent lamps 200121 ( Mercury, phosphor ) ( Concentration <1% ) ( HP6 & HP14 Hazards )
  • Sodium lamps 160213 ( Mercury , Sodium ) ( Concentration <1% ) ( HP6 & HP16 Hazards )
  • Mixed construction & Demolition waste 170904
  • Lead acid batteries 160601 ( Sulphuric Acid , Lead ) ( Concentration <1% ) ( HP3a,HP6,HP14,HP5,R35,HP8 Hazards )
  • NICad batteries 160211 ( Nickel Cadmuium ) ( concentration <1% ) ( HP3A,HP6,HP14,HP5,HP8,R35 Hazards )
  • Electrical Equipment (Hazardous) 160211 ( containing Chiofluorocarbon HCFC , HFC ) ( concentration <1%) ( HP14 hazard )

• Select refrigerant waste

  R404a Refrigerant gas ( 140601 ) UN ID ( 3337)

  R22 Chiorodifluromethane ( 140601) UN ID ( 1018)

  R410a Liquefied Gas N .O. S ( 140601) UN ID ( 3163 )

  R407c Refrigerant gas ( 140601 ) UN ID ( 3340 )

  R134a, R32. Liquefied Gas N.O.S ( 140601 ) UN ID ( 3163 )

• Physical form

  Select Solid Gas Liquid Powder Mixed Sludge

  • Solid
  • Gas
  • Liquid
  • Powder
  • Mixed
  • Sludge

• Quantity ( kg ) and Number

• Container type

  Coffin

  Box

  Tray

  Cylinder

• Cylinder Number where applicable

Part C : Carriers Certificate ( City FM RMT to complete )

• I certify that I today collected the consignment and that the details in A2 A4 and B are correct and I have been advised of any specific handling requirements

• Carrier name City FM ltd

• Carrier Registration number CBDU153003

• Vehicle registration Number

• Signature

  Sign

• Date / time

  Date

Part D : Consignor's Certificate ( Store to sign )

• I certify that the information in A, B and C is correct, that the carrier 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 any special handling requirements

• Consignor's Address
  Address

• Stores Signature

  Sign

• Date / Time

  Date

• Add EWC

add EWC

• FSW/ Electric Center to complete ( where more than one waste type is collected all of the information given must be completed for each EWC )

• Individual EWC code

  Select 170904 mixed construction 200121 Fluorescent tube 140601 R404a Refrigerant gas 160213. Sodium lamps 160601 Lead Acid Batteries 160211 Nicad Batteries 160211 Electric equipment 140601 R22 Chiorodifluromethane 140601 R410a liquified gas Nos 140601 R407a Refrigerant gas 140601 R134a , R32 liquified gas Nos

  • 170904 mixed construction
  • 200121 Fluorescent tube
  • 140601 R404a Refrigerant gas
  • 160213. Sodium lamps
  • 160601 Lead Acid Batteries
  • 160211 Nicad Batteries
  • 160211 Electric equipment
  • 140601 R22 Chiorodifluromethane
  • 140601 R410a liquified gas Nos
  • 140601 R407a Refrigerant gas
  • 140601 R134a , R32 liquified gas Nos

• Quantity of EWC code received (kg) and number

• EWC Code Accepted or Rejected

  Accepted

  Rejected

• I received this waste at the address given in A 3

• Description number

• Date / Time

  Date

• I certify that waste management licence / permit / authorised exemption no(s) state below authorises the management of the waste described in part B at the address given in A3

• Licence /Permit / Exemption No

• Signature

  Sign

• Date /Time

  Date