Form SFN60120 "Waste Rejection Report" - North Dakota

What Is Form SFN60120?

This is a legal form that was released by the North Dakota Department of Health - a government authority operating within North Dakota. 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 North Dakota Department of Health;
  • 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 SFN60120 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Health.

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Download Form SFN60120 "Waste Rejection Report" - North Dakota

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918 East Divide Avenue, 3rd Floor
WASTE REJECTION REPORT
Bismarck, ND 58501-1947
Clear Form
NORTH DAKOTA DEPARTMENT OF HEALTH
Telephone: 701-328-5166
DIVISION OF WASTE MANAGEMENT
Fax: 701-328-5200
SFN 60120 (2-2015)
This form is for use by solid waste facilities and by transporters of solid waste when a waste or a load of waste is rejected, including, but not
limited to: (a) waste containing materials not allowed for disposal, (b) transporters that do not have a valid North Dakota Solid Waste
Transporter Permit, (c) waste that fell, spilled, or leaked from a transport vehicle, or (e) other reasons (unsuited/unsafe vehicles or vehicle
operation, free liquids in loads, etc.). A signed copy of this form shall be provided to the Department at the above-noted address within 5 days
upon rejection of the waste or waste load. Print information.
Time of Waste Rejection
Date of Waste Rejection (Month/Day/Year)
A.M.
P.M.
Description and Volume of Rejected Waste
Reason for Rejection
WASTE TRANSPORTER
Company Name
Mailing Address
City
State
ZIP Code
Contact Name
Telephone Number
North Dakota Waste Hauler Permit Number (Required)
E-mail Address
WH-
Vehicle Description
License Plate Number
Driver Name
Driver Telephone Number
WHERE WAS WASTE GENERATED?
Company Name (Required)
Waste Generation Site/Location (Required)
Address
City
State
ZIP Code
Contact Name
Telephone Number
E-mail Address
FACILITY REJECTING THE WASTE
Facility Name
Address
City
State
ZIP Code
Contact Name
Telephone Number
E-mail Address
WHERE THE WASTE WAS FINALLY DISPOSED
Facility Name
Address
City
State
ZIP Code
Signature
918 East Divide Avenue, 3rd Floor
WASTE REJECTION REPORT
Bismarck, ND 58501-1947
Clear Form
NORTH DAKOTA DEPARTMENT OF HEALTH
Telephone: 701-328-5166
DIVISION OF WASTE MANAGEMENT
Fax: 701-328-5200
SFN 60120 (2-2015)
This form is for use by solid waste facilities and by transporters of solid waste when a waste or a load of waste is rejected, including, but not
limited to: (a) waste containing materials not allowed for disposal, (b) transporters that do not have a valid North Dakota Solid Waste
Transporter Permit, (c) waste that fell, spilled, or leaked from a transport vehicle, or (e) other reasons (unsuited/unsafe vehicles or vehicle
operation, free liquids in loads, etc.). A signed copy of this form shall be provided to the Department at the above-noted address within 5 days
upon rejection of the waste or waste load. Print information.
Time of Waste Rejection
Date of Waste Rejection (Month/Day/Year)
A.M.
P.M.
Description and Volume of Rejected Waste
Reason for Rejection
WASTE TRANSPORTER
Company Name
Mailing Address
City
State
ZIP Code
Contact Name
Telephone Number
North Dakota Waste Hauler Permit Number (Required)
E-mail Address
WH-
Vehicle Description
License Plate Number
Driver Name
Driver Telephone Number
WHERE WAS WASTE GENERATED?
Company Name (Required)
Waste Generation Site/Location (Required)
Address
City
State
ZIP Code
Contact Name
Telephone Number
E-mail Address
FACILITY REJECTING THE WASTE
Facility Name
Address
City
State
ZIP Code
Contact Name
Telephone Number
E-mail Address
WHERE THE WASTE WAS FINALLY DISPOSED
Facility Name
Address
City
State
ZIP Code
Signature