"Infectious Waste Generator Annual Report" - Delaware

Infectious Waste Generator Annual Report is a legal document that was released by the Delaware Department of Natural Resources and Environmental Control - a government authority operating within Delaware.

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Complete, print & mail the form below to:
DNREC
Solid and Hazardous Waste
89 Kings Highway
Dover, DE 19901
Attn: Lindsey Douglas
Infectious Waste Generator Annual Report
For Calendar Year: __________
Instructions:
1. If a transporter accepted your waste –Complete boxes 1, 2, 3, 4 & 5 of this form. If you used multiple transporters, please submit one form per transporter used.
2. If your facility rendered its waste non-infectious and non recognizable prior to disposal in a solid waste landfill – Complete boxes 1, 2, 2A & 5.
3. Please make copies of this form for future reports.
Generator Information
(1) Generator I.D. Number ________________________________________________________________________
Generator Name ______________________________________________________________________________
Location ____________________________________________________________________________________
Address_____________________________________________________________________________________
City ________________________________________ State ____________________ Zip Code_______________
Telephone (
) ______________________________________________________________________________
Description & Amount of Waste Generated
(2) Description
Number of Containers
Weight (lbs)
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Total:__________________________________________________________________________________________
(2A) Please describe how your facility rendered the infectious waste non-infectious and non-recognizable.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Transported by:
(3) Transporter Permit Number: ___________________________________________________________________
Transporter Name: ___________________________________________________________________________
Address: ___________________________________________________________________________________
Telephone: (
) _____________________________________________________________________________
Treated by: (Disposal Facility)
(4) Facility Name: ______________________________________________________________________________
Address: ___________________________________________________________________________________
Telephone: (
) _____________________________________________________________________________
Facility Name: ______________________________________________________________________________
Address: ___________________________________________________________________________________
Telephone: (
) ____________________________________________________________________________
Note: If more than two facilities were used, please include others on a separate form.
Certification
(5) I certify that the information contained in this document (and attachments) is correct.
Name & Title: _______________________________________________________________________________
Signature: ____________________________________________ Date: _________________________________
Complete, print & mail the form below to:
DNREC
Solid and Hazardous Waste
89 Kings Highway
Dover, DE 19901
Attn: Lindsey Douglas
Infectious Waste Generator Annual Report
For Calendar Year: __________
Instructions:
1. If a transporter accepted your waste –Complete boxes 1, 2, 3, 4 & 5 of this form. If you used multiple transporters, please submit one form per transporter used.
2. If your facility rendered its waste non-infectious and non recognizable prior to disposal in a solid waste landfill – Complete boxes 1, 2, 2A & 5.
3. Please make copies of this form for future reports.
Generator Information
(1) Generator I.D. Number ________________________________________________________________________
Generator Name ______________________________________________________________________________
Location ____________________________________________________________________________________
Address_____________________________________________________________________________________
City ________________________________________ State ____________________ Zip Code_______________
Telephone (
) ______________________________________________________________________________
Description & Amount of Waste Generated
(2) Description
Number of Containers
Weight (lbs)
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Total:__________________________________________________________________________________________
(2A) Please describe how your facility rendered the infectious waste non-infectious and non-recognizable.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Transported by:
(3) Transporter Permit Number: ___________________________________________________________________
Transporter Name: ___________________________________________________________________________
Address: ___________________________________________________________________________________
Telephone: (
) _____________________________________________________________________________
Treated by: (Disposal Facility)
(4) Facility Name: ______________________________________________________________________________
Address: ___________________________________________________________________________________
Telephone: (
) _____________________________________________________________________________
Facility Name: ______________________________________________________________________________
Address: ___________________________________________________________________________________
Telephone: (
) ____________________________________________________________________________
Note: If more than two facilities were used, please include others on a separate form.
Certification
(5) I certify that the information contained in this document (and attachments) is correct.
Name & Title: _______________________________________________________________________________
Signature: ____________________________________________ Date: _________________________________