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Form HWCN01v111

First 6 digits must match the This section must consist of 5 numbers
The Hazardous Waste Regulations 2005:
premise code in Part A.3 or letters - no more, no less. they can be
Consignment Note whatever you choose.
PRODUCERS/HOLDERS/CONSIGNORS COPY (Delete as appropriate)

PART A Notification details


1 Consignment note code: / 4 The waste will be taken to (name, address and postcode):

2 The waste described below is to be removed from (name, address, Biogenie Soil Treatment Facility,
postcode, telephone, e-mail, facsimile): Cormongers Lane, Redhill, RH14ER - HAS TO BE THIS
FULL Site address required. Simply writing "Bob Smith Construction,
5 The waste producer was (if different from 2) (name, address,
Redhill, RH1 4ER is not enough postcode, telephone, e-mail, facsimile):
This box MUST be completed. You are allowed to write
3 Premises code (where applicable):
"As A2" if the address is the same as section 2.
PART B Description of the waste
MUST be a full description. e.g.
If continuation sheet used, tick here
1 The process giving rise to the waste(s) was: excavation of contaminated 2 SIC for the process giving rise to the waste: Must be
. completed
/
soils.
3 WASTE DETAILS (where more than one waste type is collected all of the information given below must be completed for each EWC identified)

Description of waste List of wastes Quantity The chemical/biological components in Physical form Hazard Container
(EWC code)(6 digits) (kg) the waste and their concentrations are: (gas, liquid, solid, code(s) type, number
Component Concentration powder, sludge and size
(% or mg/kg) or mixed)
e.g. Hazardous soils and All these boxes must be completed. Quantity can be guessed at.
stones

The information given below is to be completed for each EWC identified


EWC code UN identification Proper shipping name(s) UN class(es) Packing group(s) Special handling
number(s) requirements
You only need to complete this section if the hazardous waste is dangerous for carriage.

PART C Carriers certificate PART D Consignors certificate


(If more than one carrier is used, please attach schedule for subsequent carriers. If schedule of I certify that the information in A, B and C has been
carriers is attached tick here. ) completed and is correct, that the carrier is registered or
I certify that I today collected the consignment and that the details in A2, A4 and B3 are exempt and was advised of the appropriate precautionary
correct and I have been advised of any specific handling requirements. measures. All of the waste is packaged and labelled
correctly and the carrier has been advised of any special
Where this note comprises part of a multiple collection the round number and collection number are: handling requirements.
Where applicable, the first section must be 15 digits. e.g.
/ 123456789123456/01 I confirm that I have fulfilled my duty to apply the waste
hierarchy as required by Regulation 12 of the Waste
1 Carrier name: e.g. Bob Smith of Bob Smith Haulage Ltd. (England and Wales) Has to be the
Regulations name of the person who fills
2011.
On behalf of (name, address, postcode, telephone, e-mail, facsimile): 1 Consignor name: this ticket in, not a company name.
Must be the FULL address of the haulage company. Writing "Bob Smith Haulage On behalf of (name, address, postcode, telephone, e-mail,
Ltd, Redhill" is not acceptable. Phone and email are not a neccessity facsimile):
2 Carrier registration no./reason for exemption: The full address of who the consignee works for,
Hauliers carrier registration goes here plus signature.
3 Vehicle registration no. (or mode of transport, if not road):
e.g. ABCD123
Signature DRIVER MUST SIGN Signature
Date Date
D D &MTime
M MUST
Y Y Ybe YfilledTime
in H H MM Date Date
D D &MTime
M MUST
Y Y Ybe YfilledTime
in H H MM
PART E Consignees certificate (where more than one waste type is collected all of the information given below must be completed for each EWC)
Individual EWC Quantity of each EWC code received (kg) EWC code Waste management operation (R or D code)
BIOGENIE
code(s) received
COMPLETE THIS SECTION. YOU DO NOT NEED
accepted/rejected
TO WRITE ANYTHING HERE.

1 I received this waste at the address given in A4 on: Date D D M M Y Y Y Y Time H H M M

2 Vehicle registration no. (or mode of transport if not road): Name:


On behalf of (name, address, postcode, telephone, e-mail,
3 Where waste is rejected please provide details: facsimile):

I certify that waste permit/exempt waste operation number:

authorises the management of the waste described in B at the address


given in A4.
Signature
Where the consignment forms part of a multiple collection,
as identified in Part C, I certify that the total number of Date D D M M Y Y Y Y Time H H M M
consignments forming the collection are:

HWCN01v111
Form HWCN01v111

The Hazardous Waste Regulations 2005:


Consignment Note
CARRIERS COPY
PART A Notification details
1 Consignment note code: / 4 The waste will be taken to (name, address and postcode):

2 The waste described below is to be removed from (name, address,


postcode, telephone, e-mail, facsimile):

5 The waste producer was (if different from 2) (name, address,


postcode, telephone, e-mail, facsimile):

3 Premises code (where applicable):

PART B Description of the waste If continuation sheet used, tick here


1 The process giving rise to the waste(s) was: 2 SIC for the process giving rise to the waste: . /

3 WASTE DETAILS (where more than one waste type is collected all of the information given below must be completed for each EWC identified)

Description of waste List of wastes Quantity The chemical/biological components in Physical form Hazard Container
(EWC code)(6 digits) (kg) the waste and their concentrations are: (gas, liquid, solid, code(s) type, number
Component Concentration powder, sludge and size
(% or mg/kg) or mixed)

The information given below is to be completed for each EWC identified


EWC code UN identification Proper shipping name(s) UN class(es) Packing group(s) Special handling
number(s) requirements

PART C Carriers certificate PART D Consignors certificate


(If more than one carrier is used, please attach schedule for subsequent carriers. If schedule of I certify that the information in A, B and C has been
carriers is attached tick here. ) completed and is correct, that the carrier is registered or
I certify that I today collected the consignment and that the details in A2, A4 and B3 are exempt and was advised of the appropriate precautionary
correct and I have been advised of any specific handling requirements. measures. All of the waste is packaged and labelled
correctly and the carrier has been advised of any special
Where this note comprises part of a multiple collection the round number and collection number are: handling requirements.
/ I confirm that I have fulfilled my duty to apply the waste
hierarchy as required by Regulation 12 of the Waste
1 Carrier name: (England and Wales) Regulations 2011.
On behalf of (name, address, postcode, telephone, e-mail, facsimile): 1 Consignor name:
On behalf of (name, address, postcode, telephone, e-mail,
facsimile):
2 Carrier registration no./reason for exemption:

3 Vehicle registration no. (or mode of transport, if not road):

Signature Signature
Date D D M M Y Y Y Y Time H H M M Date D D M M Y Y Y Y Time H H M M

PART E Consignees certificate (where more than one waste type is collected all of the information given below must be completed for each EWC)
Individual EWC Quantity of each EWC code received (kg) EWC code Waste management operation (R or D code)
code(s) received accepted/rejected

1 I received this waste at the address given in A4 on: Date D D M M Y Y Y Y Time H H M M

2 Vehicle registration no. (or mode of transport if not road): Name:


On behalf of (name, address, postcode, telephone, e-mail,
3 Where waste is rejected please provide details: facsimile):

I certify that waste permit/exempt waste operation number:

authorises the management of the waste described in B at the address


given in A4.
Signature
Where the consignment forms part of a multiple collection,
as identified in Part C, I certify that the total number of Date D D M M Y Y Y Y Time H H M M
consignments forming the collection are:

HWCN01v111
Form HWCN01v111

The Hazardous Waste Regulations 2005:


Consignment Note
CONSIGNEES COPY
PART A Notification details
1 Consignment note code: / 4 The waste will be taken to (name, address and postcode):

2 The waste described below is to be removed from (name, address,


postcode, telephone, e-mail, facsimile):

5 The waste producer was (if different from 2) (name, address,


postcode, telephone, e-mail, facsimile):

3 Premises code (where applicable):

PART B Description of the waste If continuation sheet used, tick here


1 The process giving rise to the waste(s) was: 2 SIC for the process giving rise to the waste: . /

3 WASTE DETAILS (where more than one waste type is collected all of the information given below must be completed for each EWC identified)

Description of waste List of wastes Quantity The chemical/biological components in Physical form Hazard Container
(EWC code)(6 digits) (kg) the waste and their concentrations are: (gas, liquid, solid, code(s) type, number
Component Concentration powder, sludge and size
(% or mg/kg) or mixed)

The information given below is to be completed for each EWC identified


EWC code UN identification Proper shipping name(s) UN class(es) Packing group(s) Special handling
number(s) requirements

PART C Carriers certificate PART D Consignors certificate


(If more than one carrier is used, please attach schedule for subsequent carriers. If schedule of I certify that the information in A, B and C has been
carriers is attached tick here. ) completed and is correct, that the carrier is registered or
I certify that I today collected the consignment and that the details in A2, A4 and B3 are exempt and was advised of the appropriate precautionary
correct and I have been advised of any specific handling requirements. measures. All of the waste is packaged and labelled
correctly and the carrier has been advised of any special
Where this note comprises part of a multiple collection the round number and collection number are: handling requirements.
/ I confirm that I have fulfilled my duty to apply the waste
hierarchy as required by Regulation 12 of the Waste
1 Carrier name: (England and Wales) Regulations 2011.
On behalf of (name, address, postcode, telephone, e-mail, facsimile): 1 Consignor name:
On behalf of (name, address, postcode, telephone, e-mail,
facsimile):
2 Carrier registration no./reason for exemption:

3 Vehicle registration no. (or mode of transport, if not road):

Signature Signature
Date D D M M Y Y Y Y Time H H M M Date D D M M Y Y Y Y Time H H M M

PART E Consignees certificate (where more than one waste type is collected all of the information given below must be completed for each EWC)
Individual EWC Quantity of each EWC code received (kg) EWC code Waste management operation (R or D code)
code(s) received accepted/rejected

1 I received this waste at the address given in A4 on: Date D D M M Y Y Y Y Time H H M M

2 Vehicle registration no. (or mode of transport if not road): Name:


On behalf of (name, address, postcode, telephone, e-mail,
3 Where waste is rejected please provide details: facsimile):

I certify that waste permit/exempt waste operation number:

authorises the management of the waste described in B at the address


given in A4.
Signature
Where the consignment forms part of a multiple collection,
as identified in Part C, I certify that the total number of Date D D M M Y Y Y Y Time H H M M
consignments forming the collection are:

HWCN01v111