Section A: Waste Producer Details:
Name (Required):
Address (Required):
Email (Required):
Contact Number:
Company Name:

Section B: Waste Details:
Waste Description:
Type of Waste: Hazardous
Physical State of Waste:
Total quantity in Kilograms (kg):
Packaging of Waste:
Frequency of Disposal:
EWC Code:
Requirements of disposal (e.g. Supervision):
Is a certificate of Destruction Required?:

Section C: Waste Haulier Details
Vehicle Registration Number:
Contact No.:

Section D: Client Documentation (select if present)
Vehicle registration with ERA:
Vehicle registration with Wasteserv:
ERA waste consignment permit if waste is Hazardous:
VPRD waste consignment permit if waste is animal by-product:
Waste Transfer Note:

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