Form MO780-2531 "Registration for Hazardous Waste Generator E-Reporting" - Missouri

What Is Form MO780-2531?

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

Form Details:

  • Released on February 1, 2015;
  • The latest edition provided by the Missouri Department of Natural Resources;
  • 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 Form MO780-2531 by clicking the link below or browse more documents and templates provided by the Missouri Department of Natural Resources.

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Download Form MO780-2531 "Registration for Hazardous Waste Generator E-Reporting" - Missouri

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MISSOURI DEPARTMENT OF NATURAL RESOURCES
HAZARDOUS WASTE PROGRAM
REGISTRATION FOR HAZARDOUS WASTE GENERATOR E-REPORTING
Complete this form to register a hazardous waste generator for electronic reporting. This form should also be used to identify or change
authorized representatives assigned to have access to your e-Reporting for the Department of Natural Resources, Hazardous Waste
Program Generator e-Reporting System.
PART A - GENERATOR INFORMATION
EPA ID #
MO ID #
FACILITY NAME
ADDRESS
ADDRESS LINE 2
CITY
STATE
ZIP CODE
REVISED GENERATOR OR ACCOUNT INFO ☐
NEW APPLICATION ☐
REQUEST FOR REACTIVATION ☐
DEACTIVATION DATE
REQUEST FOR DEACTIVATION ☐
PART B - USER ACCOUNT INFORMATION
USER ACCOUNT ACTION
ADD ☐
UPDATE ☐
DEACTIVATE ☐
LAST NAME
FIRST NAME
CITIZEN APPLICATION GATEWAY USER NAME
ACCOUNT TYPE
CERTIFIER ☐
PREPARER ☐
VIEWER ☐
EMPLOYER’S NAME
JOB TITLE
EMAIL
TELEPHONE NUMBER WITH AREA CODE
ADDRESS
CITY
STATE
ZIP CODE
USER ACCOUNT ACTION
ADD ☐
UPDATE ☐
DEACTIVATE ☐
LAST NAME
FIRST NAME
CITIZEN APPLICATION GATEWAY USER NAME
ACCOUNT TYPE
CERTIFIER ☐
PREPARER ☐
VIEWER ☐
EMPLOYER’S NAME
JOB TITLE
EMAIL
TELEPHONE NUMBER WITH AREA CODE
ADDRESS
CITY
STATE
ZIP CODE
USER ACCOUNT ACTION
ADD ☐
UPDATE ☐
DEACTIVATE ☐
LAST NAME
FIRST NAME
CITIZEN APPLICATION GATEWAY USER NAME
ACCOUNT TYPE
CERTIFIER ☐
PREPARER ☐
VIEWER ☐
EMPLOYER’S NAME
JOB TITLE
EMAIL
TELEPHONE NUMBER WITH AREA CODE
ADDRESS
CITY
STATE
ZIP CODE
MO 780-2531 (02-15)
Page 1
MISSOURI DEPARTMENT OF NATURAL RESOURCES
HAZARDOUS WASTE PROGRAM
REGISTRATION FOR HAZARDOUS WASTE GENERATOR E-REPORTING
Complete this form to register a hazardous waste generator for electronic reporting. This form should also be used to identify or change
authorized representatives assigned to have access to your e-Reporting for the Department of Natural Resources, Hazardous Waste
Program Generator e-Reporting System.
PART A - GENERATOR INFORMATION
EPA ID #
MO ID #
FACILITY NAME
ADDRESS
ADDRESS LINE 2
CITY
STATE
ZIP CODE
REVISED GENERATOR OR ACCOUNT INFO ☐
NEW APPLICATION ☐
REQUEST FOR REACTIVATION ☐
DEACTIVATION DATE
REQUEST FOR DEACTIVATION ☐
PART B - USER ACCOUNT INFORMATION
USER ACCOUNT ACTION
ADD ☐
UPDATE ☐
DEACTIVATE ☐
LAST NAME
FIRST NAME
CITIZEN APPLICATION GATEWAY USER NAME
ACCOUNT TYPE
CERTIFIER ☐
PREPARER ☐
VIEWER ☐
EMPLOYER’S NAME
JOB TITLE
EMAIL
TELEPHONE NUMBER WITH AREA CODE
ADDRESS
CITY
STATE
ZIP CODE
USER ACCOUNT ACTION
ADD ☐
UPDATE ☐
DEACTIVATE ☐
LAST NAME
FIRST NAME
CITIZEN APPLICATION GATEWAY USER NAME
ACCOUNT TYPE
CERTIFIER ☐
PREPARER ☐
VIEWER ☐
EMPLOYER’S NAME
JOB TITLE
EMAIL
TELEPHONE NUMBER WITH AREA CODE
ADDRESS
CITY
STATE
ZIP CODE
USER ACCOUNT ACTION
ADD ☐
UPDATE ☐
DEACTIVATE ☐
LAST NAME
FIRST NAME
CITIZEN APPLICATION GATEWAY USER NAME
ACCOUNT TYPE
CERTIFIER ☐
PREPARER ☐
VIEWER ☐
EMPLOYER’S NAME
JOB TITLE
EMAIL
TELEPHONE NUMBER WITH AREA CODE
ADDRESS
CITY
STATE
ZIP CODE
MO 780-2531 (02-15)
Page 1
PART C - GENERATOR REGISTRATION
I request the above identified generator be registered for electronic reporting. I agree that the listed certifiers will follow the
requirements and procedures for the electronic submissions of the “Generator’s Hazardous Waste Summary Report” (MO
780-1097), and the “Facility Summary Report” (MO 780-0408) as described in the e-reporting guide.
Please establish or revise the above user accounts in accordance with the information provided for each identified account. The
persons identified as the certifiers are hereby designated as the authorized representatives for all reporting purposes. I understand
that each person to receive a certifier account must complete Part D of this form and must sign in the presence of a Notary Public.
I certify, under penalty of law, I have personally examined and am familiar with the information submitted in this application and all
attachments. Based on my inquiry of those persons immediately responsible for obtaining the information contained in the application,
I believe the information is true, accurate and complete. I am aware there are significant penalties for submitting false information,
including the possibility of fine and imprisonment.
SIGNATURES OF AUTHORIZED REPRESENATIVES
GENERATOR NAME (PRINT OR TYPE)
GENERATOR SIGNATURE
DATE
OFFICIAL TITLE (PRINT OR TYPE)
PART D - CERTIFIER REGISTRATION
The generator and certifier intend to have the submission of the “Generator’s Hazardous Waste Summary Report” (MO 780-1097) and
the “Facility Summary Report” (MO 780-0408) be the functional equivalent of the paper submissions as required by the Hazardous
Waste Management Law, Sections 260.380(8) and 260.390(6), RSMo. The certifier will use a validly issued PIN as a signature when
submitting reports. The permit holder and certifier agree not to contest the validity of the reports submitted under an authorized PIN
based on the facts such submissions were completed electronically. The generator and certifier further agree the provisions of the
Uniform Electronic Transactions Act, Sections 432.200 through 432.295, RSMo, shall apply, except as otherwise stated herein or
within the e-reporting guide.
The generator and certifier agree:
1.
Any reports submitted under the PIN specific to the certifier shall be considered a signed paper report; and any such records
shall be deemed for all purposes:
To have been “signed” by the certifier.
To constitute an “original” when printed from electronic files or records.
MO 780-2531 (02-15)
Page 2
2.
Electronic reports constitute admissible evidence in any judicial or administrative proceeding.
An electronically submitted report will not satisfy a reporting requirement until it has been received and accepted by the department.
If an electronically submitted report is rejected, the generator shall take the necessary steps to properly resubmit such reports within
three (3) business days of the notice of rejection.
By signing below, the generator and certifier agree with the terms and conditions of Part D.
Please include the following documents with your application.
Copy of certifier’s identification (e.g. driver’s license); and
1.
2.
Proof of ownership or association with generator.
SIGNATURES
GENERATOR (MUST SIGN IN THE PRESENCE OF NOTARY)
DATE
CERTIFIER (MUST SIGN IN THE PRESENCE OF NOTARY)
DATE
NOTARY PUBLIC
DATE
MAIL COMPLETED COPY TO:
MISSOURI DEPARTMENT OF NATURAL RESOURCES,
HAZARDOUS WASTE PROGRAM,
BUDGET AND PLANNING SECTION,
P.O. BOX 176, JEFFERSON CITY, MO 65102-0176
PHONE: 800-361-4827 or 573-751-3204
FAX: 573-751-7869
FOR OFFICE USE ONLY
RECEIVED BY
DATE
APPROVED BY
DATE
FEES AND TAXES UPDATED BY
DATE
MO 780-2531 (02-15)
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