Waste Declaration - Ascri Environmental

Waste producer *

SIC Code *

Contact name *

Contact number *

Email address *

Waste producer business address *

Town / City *

Postcode *

Waste carrier *

Waste carrier registration number *

Waste carrier expiry date *

Contact name *

Contact number *

Email address *

Type of waste *

Inert

Non-hazardous

Hazardous

Waste EWC Code *

Anticipated volume of waste *

Anticipated dates of disposal *

Full address of source of waste *

Town / City *

Postcode *

SIC Code for site where waste is produced, if different to waste producer business address code *

Existing and previous use of the site where waste is produced *

Process giving rise to the production of waste *

Physical appearance of the waste (description/composition/ colour) *

Does the waste have any odours? If Yes, please describe *

Supporting files

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I confirm that the waste described on this form and any attached information is accurate. Should the waste change in any way Plasmor Ltd will be contacted immediately and a new Waste Declaration Form will be submitted accordingly prior to removal from the source site. 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.

I accept that should my waste not be correctly classified or found to be contaminated, the waste will be rejected for deposition at the site or, if already deposited, quarantined for the removal from site. I further accept that Plasmor Ltd reserves the right to charge me for any additional costs incurred through failure to comply with these requirements or due to any false declaration, whether intentional or not.

Name *

Signature *

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Date *

Job title/position *