Title Page
Section A - Description of waste
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A1 Description of the waste being transferred
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List Of Waste Regulations Code (s)
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A2 How Is The Waste Contained ?
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A3 How Much Waste ? For Example, Number of Sacks,
Section B - Current Holder Of the waste - Transferor
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B1 Full Name - 859 LIMITED
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By Signing in Section D below I confirm that I have fulfilled my duty to apply the waste hierarchy as required by Regulation 12 of the waste (England and Wales) Regulations 2011
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Company Name and Address - RAINBOW HOUSE UNIT 17, FLITCH INDUSTRAIL ESTATE, GREAT DUNMOW, ESSEX, CM6 1XJ
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B2 Name Of Your Unitary Authority Or Council - ENVIRONMENT AGENCY - SHEFFIELD
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B3 Are You ?
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The Producer of the waste ?
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The Importer of the waste ?
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The Producer of the waste ?
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The Local Authority ?
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The Older of an Environment Permit ?
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Permit Number
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Issued By
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Registered Waste Exemption ?
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Details Including Registration Number ?
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A Registered Waste Carrier, Broker, Or Dealer?
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Registration Number - CBDU82860
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Details (Are you a carrier, broker or dealer ?) CARRIER AND DEALER
Section C- Person collecting the waste - Transferee
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C1 Full Name - 859 LIMITED
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Company Name and Address - RAINBOW HOUSE UNIT 17, FLITCH INDUSTRAIL ESTATE, GREAT DUNMOW, ESSEX, CM6 1XJ
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Are you The Local Authority ? NO
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The Older of an Environment Permit ?
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Permit Number
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Issued By
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Registered Waste Exemption
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Details Including Registration Number ?
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A Registered Waste Carrier, Broker, Or Dealer?
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Registration Number - CBDU82860
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Details (Are you a carrier, broker or dealer ?) CARRIER
Section D- The Transfer
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D1 Address of transfer or collection point
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Date Of Transfer
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D2 Broker or dealer who arranged this transfer (if applicable)
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Postcode
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Registration Number
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Time(s)
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Policy Holders Signature
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Technicians Signature
