DTSC Form 187 "Hazardous Waste Transporter Registration Application" - California

What Is DTSC Form 187?

This is a legal form that was released by the California Department of Toxic Substances Control - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2020;
  • The latest edition provided by the California Department of Toxic Substances Control;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DTSC Form 187 by clicking the link below or browse more documents and templates provided by the California Department of Toxic Substances Control.

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Download DTSC Form 187 "Hazardous Waste Transporter Registration Application" - California

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California Environmental Protection Agency
Department of Toxic Substances Control
Transportation Unit
1001 I Street MS 11-A, Sacramento, CA 95814
Phone: (800) 618-6942 Fax: (916) 323-3500
Hazardous Waste Transporter Registration Application
DTSC Form 187 (Revision 04/2020)
1. Name of Legal Entity (Individual, Partnership, Corporation, or Limited Liability
Company):
______________________________________________________________________
2. Transporter Registration Number (if renewal or reinstatement):__________________
3. Business Name (Show DBA name, show name exactly as it will appear on
registration; same name or trademark is required on all vehicles):
______________________________________________________________________
4. Application Type (check one):
New
Renewal
Reinstatement
Mid-year Amendment
5. Business Address:_____________________________________________________
Street
______________________________________________________________________
City
State
County
ZIP Code
6. Mailing Address (if different from above): ___________________________________
Street/P.O. Box
______________________________________________________________________
City
State
County
ZIP Code
7. a) Telephone Number: ___________________ b) Fax Number: _________________
(ext.)
c) E-mail Address: ______________________________________________________
8.Transporter EPA Identification (ID) Number(s). List all the 12-character EPA ID
numbers that your business uses to transport hazardous waste. If necessary, list
additional EPA ID numbers on a separate sheet.
a) ________________________________ b) ________________________________
c) ________________________________ d) _________________________________
California Environmental Protection Agency
Department of Toxic Substances Control
Transportation Unit
1001 I Street MS 11-A, Sacramento, CA 95814
Phone: (800) 618-6942 Fax: (916) 323-3500
Hazardous Waste Transporter Registration Application
DTSC Form 187 (Revision 04/2020)
1. Name of Legal Entity (Individual, Partnership, Corporation, or Limited Liability
Company):
______________________________________________________________________
2. Transporter Registration Number (if renewal or reinstatement):__________________
3. Business Name (Show DBA name, show name exactly as it will appear on
registration; same name or trademark is required on all vehicles):
______________________________________________________________________
4. Application Type (check one):
New
Renewal
Reinstatement
Mid-year Amendment
5. Business Address:_____________________________________________________
Street
______________________________________________________________________
City
State
County
ZIP Code
6. Mailing Address (if different from above): ___________________________________
Street/P.O. Box
______________________________________________________________________
City
State
County
ZIP Code
7. a) Telephone Number: ___________________ b) Fax Number: _________________
(ext.)
c) E-mail Address: ______________________________________________________
8.Transporter EPA Identification (ID) Number(s). List all the 12-character EPA ID
numbers that your business uses to transport hazardous waste. If necessary, list
additional EPA ID numbers on a separate sheet.
a) ________________________________ b) ________________________________
c) ________________________________ d) _________________________________
9. Other Business Address(es). List all locations from which you will operate under this
registration. If necessary, list additional business addresses on a separate sheet.
a) ____________________________________________________________________
Street
______________________________________________________________________
City
County/Province
State/Country
ZIP Code
b) ____________________________________________________________________
Street
______________________________________________________________________
City
County/Province
State/Country
ZIP Code
10. Ownership of Business (Check one):
Sole Proprietor
Partnership
Corporation
LLC
Other ________________
If a sole proprietor or partnership, list name(s) or title(s) of all members. If you do not
have any California locations, include the Agent for Service of Process listed with the
Secretary of State. If a corporation or limited liability company (LLC), list name(s) and
title(s) of officers including Agent for Service of Process. If necessary, list additional
names on a separate sheet.
a) ____________________________________________________________________
Name
Title
b) ____________________________________________________________________
Name
Title
Agent for Service of Process
Name: ________________________________________________________________
______________________________________________________________________
Address
Note: Transportation of hazardous waste without proper registration and public
liability insurance is a violation of the Health and Safety Code, sections 25163 and
25169, and may subject you to significant penalties.
11. I understand and will comply with all the applicable hazardous waste transportation
requirements including chapter 6.5, division 20, of the California Health and Safety
Code; chapter 13, division 4.5, title 22, California Code of Regulations; and federal laws
and regulations governing the use of manifests. I certify under penalty of perjury to the
accuracy of all statements made herein.
Authorized Representative (print or type):_____________________________________
Name
Title
______________________________________________________________________
Signature (Use blue or other non-black ink.)
Date
Hazardous Waste Transportation Registration Application Instructions
1. Name of Legal Entity
Enter the name under which you are applying for the registration. You must
complete both lines 1 and 3 even if they are the same.
2. Transporter Registration Number
For new application, leave blank. For renewal, reinstatement, or mid-year
amendment, enter your current registration number.
3. Business Name
• Enter the name, the “DBA” (doing business as) name, or fictitious name under
which you are doing business. This will be the same name that will appear on the
Registration Certificate issued by DTSC, the Certificate of Insurance for Public
Liability Coverage (DTSC Form 8038), and the Endorsement for Motor Carrier
Policies of Insurance for Public Liability (Form MCS-90).
• If you have more than one DBA or fictitious name, you must apply for a separate
registration for each DBA or fictitious name under which you will transport
hazardous waste.
• The name (or logo) shown on the registration certificate MUST be displayed on
all vehicles and must be shown on the California Uniform Hazardous Waste
Manifest.
4. Application Type
Check the appropriate application type.
5. Business Address
Enter the complete business address.
6. Mailing Address
Enter the complete mailing address.
7. Contact Numbers
Enter the telephone number, fax number and e-mail address of the business contact
person.
8. Transporter Identification Number (Also known as the EPA ID number)
You must have an EPA identification number to transport hazardous waste. Current
EPA identification numbers consist of three letters followed by nine digits.
Previous/early federally issued EPA identification numbers consist of two letters
followed by ten digits.
• If you plan to transport non-RCRA hazardous waste and do not have an EPA
identification number, complete DTSC Form 1358 and submit to DTSC along
with your application for registration. DTSC will assign an EPA identification
number to you and place this number on your application.
• If you plan to transport RCRA hazardous waste, you must submit the EPA Form
8700-12 to the Department of Toxic Substances Control (DTSC), ATTN:
Transportation, P.O. Box 806, Sacramento, CA 95812. Indicate on the
registration application that the EPA identification number is pending, submit your
application and registration to DTSC.
For transporters with more than one EPA identification number, list all EPA
identification numbers that your business uses to transport hazardous waste. If
necessary, list additional EPA identification numbers on a separate sheet.
9. Other Business Address(es)
• If you have more than one business location, list all the following applicable
locations:
• Terminals, transfer facilities, or other locations from which you intend to operate
under this registration.
• All locations at which you regularly park any of your vehicle(s) or containers used
to transport hazardous waste.
• All locations at which business and operating records relating to your hazardous
waste activities can be found. These records should include, but are not limited
to, manifests and other shipping papers, driver’s logs, vehicle maintenance
records, licenses, permits, and registrations.
10. Ownership of Business
Check the appropriate box.
• Sole proprietorship and Partnership: list name(s) and title(s) of all members. If
you have no California locations, include an agent for service of process (the
person authorized to accept legal service) listed with the Secretary of State.
• Corporation and Limited Liability Company: list name(s) and title(s) of officers,
including agent for service of process (the person authorized to accept legal
service and whose name is shown on the Articles of Incorporation).
• Other: Please describe.
11. Authorized Representative’s Name, Title, Signature and Date
The business owner or officer who is authorized to make decisions for the business
shall sign in the space provided using blue or other non-black ink. Enter the full
printed name and title of the person signing the form, and the date that the form was
signed.
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