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info@biocleanjetting.co.uk
0121 493 2332

Bio Clean Jetting Ltd
The White House
Illey Lane, Halesowen
West Midlands, B62 0HJ

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t: 0121 493 2332
m: 07947 932 060
e: info@biocleanjetting.co.uk
www.biocleanjetting.co.uk

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THE HAZARDOUS WASTE
REGULATIONS 2005
CONSIGNMENT NOTE

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PART A Notification details
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1. Consignment note code:
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3. The waste will be taken to (name, address and postcode):
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2. The waste described below is to be removed from (name, address, postcode, telephone, email, facsimile):
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4. The waste producer was (if different from 2) (name, address, postcode, telephone, email, facsimile):
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PART B Description of the waste
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1. The process giving rise to the waste(s) was:
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2. SIC (2007) for the process giving rise to the waste:
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3. WASTE DETAILS (where more than one waste type is collected, all of the information given below must be completed for each EWC identified)
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Description of waste


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List of wastes (EWC code)


6 Digits
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Quantity (KG)

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The chemical/biological components in the waste and their concentrations are:
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Component
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Concentration
(% or mg/kg)
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Physical form

(gas, liquid, solid, powder, sludge or mixed)
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Hazard code(s)

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Container type, number and size

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The information given below is to be completed for each EWC identified:
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EWC code
6 Digits
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UN identification number(s)
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Proper shipping name(s)
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UN class(es)
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Packing group(s)
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Special handling requirements
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PART C Carrier's certificate
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PART D Consignors certificate
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If more than one carrier is used, please click the "add" button to add the schedule for subsequent carriers. They will populate below.
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I certify that I, today collected the consignment and that the details in A2, A3 and B3 are correct and I have been advised of any specific handling requirements.
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Where this note comprises part of a multiple collection the round number and collection number are:
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1. Carrier name: on behalf of (name, address, postcode, telephone, email, facsimile):
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Bio Clean Jetting limited, The White House, Illey lane, Halesowen, West Midlands, B62 0HJ

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2. Carrier registration no./reason for exemption:
CBDU140889
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3. Vehicle registration no. (or mode of transport, if not road):
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I certify that the information in A, B and C has been completed and is correct, that the carrier is registered or exempt and was advised of the appropriate precautionary measures. All of the waste is packaged and labelled correctly and the carrier has been advised of any special handling requirements.
I confirm that I have fulfilled my duty to apply the waste hierarchy as required by Regulation 12 of the Waste (England and Wales) Regulations 2011.
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1. Consignor name:
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On behalf of (name, address, postcode, telephone, email, facsimile):
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Signature:
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Select a date
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Select a date
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Signature:
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Select a date
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Select a time
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PART E Consignee's certificate
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Individual EWC code(s) received

6 Digits
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Quantity of each EWC code received (kg)
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EWC code accepted/rejected
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Waste management operation (R or D code)
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1. I received this waste at the address given in A3 on:
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Select a date
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Select a time
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2. Vehicle registration no. (or mode of transport if not road):
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3. Where waste is rejected please provide details:
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I certify that waste permit/exempt waste operation number:
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authorises the management of the waste described in B at the address given in A3.
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Name:
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On behalf of (name, address, postcode, telephone, email, facsimile):
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Signature:
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Select a date
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Select a time
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Where the consignment forms part of a multiple collection, as identified in part C, I certify that the total number of consignments forming the collection are:
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E-mail address:
Enter the email address you would like this consignment note to be sent to.
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E-mail address:
Enter the email address you would like this consignment note to be sent to.
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Submit

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