ARCHIRODON GROUP NV

Integrated Management System

Health, Safety & Environment (HSE)

Rev.
Issued For
General Use
Reference No. HSE-PRO-08-F01
Serial No.
Page
1 of 1

FORM
Hazardous Waste Transfer Note

0.1

Hazardous Waste Transfer Note

Section A -To be completed by Group Company from where waste is transported

:
1-Name of Group Company ..

Project/Office/CFY

2- Description of waste to be transported .

3- How is the waste contained? - Tick appropriate box(es).

Loose
Sacks

Skip

Steel murD

Plastic Drum

Other

4- Quantity of waste (Number of sacks, drum, etc)

)--- , (

5- Name of contact person .

Signature

Date .

Section B -To be completed by party transporting the waste

:
1-

Company Name..

2-

Which of the following are you? tick one or more box.

Registered waste carrier, authorized for

transport of Hazardous waste

Registered number ..

Exempt from requirements to register

3-

Issued by .

Give reason ..

Method by which waste is transported (eg. Trucks, pick up,--) ..

)---------, (
4-

Vehicle Plate No.

5-

Destination to which waste is transported .

6-

Date/Time waste is collected ..

7-

Name of person who does the transport .

Signature

Section C -To be completed by party receiving the waste (at final destination)
:
12-

Location..Tel No.

Date & time waste received

3-

Was the waste received in accordance with A2 & A3 & A4..

A4 & A3 & A2,

4-

Name..

Signature..

Completed by

Approved by

Job Position

Job Position

Name Surname

Name Surname

Signature

Signature

Date

Date

Distribution List
Job Position

HSE Department