Waste Information Form

Account Information:

Your Company Name: *

Contact Name: *

Contact Number: *

Email Address: *

Job Start Date: *

Producer of Waste Information:

Full Site Address: *

Sites Former Use: *

Producers Name: *

Your company’s role in the disposal of the waste: * Sub-contactorBroker / DealerCarrier

Broker / Dealer Licence No.:

Type of Waste

Origin of the Waste: * Single sourceMultiple source

EWC Code of waste: *

Quantity of Waste: *

The process which produced the waste: *

Description of the waste, please detail the type and appearance of waste: *

Physical appearance including colour and texture: *

Site investigation / WAC test available? * yesno

If you have clicked yes, please email the relevant information to gebdykes@lightwaterquarries.com.

Signed by: *

Signature Date: *

Waste Hierarchy Declaration: * 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.

Account Information:

Producer of Waste Information:

Type of Waste

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