Administrative form for proposed movements of hazardous wastes or hazardous recyclable materials
4. Authorized Carrier
Registration Number: Name: Address:
Modes of Transport:
Road Rail Marine Air
If other authorized carriers used, attach a list.
AttachedTel. No.: Fax No.: Email address: Contact person: Name of Insurance Company: Policy No.:
10. Hazardous Information
(For additional hazardous information please see Appendix to the Notice.)
11. Exports of Hazardous Waste:
Options considered for reducing or phasing out of the waste and the reason the disposal is happening outside of Canada
12. Statement of Person Submitting the Notice:
In the case of an export or import, the contract(s) referred to in paragraphs 9(f) or 16(e) is/are in force and if the waste or material cannot be disposed of or recycled in accordance with the export or import permit, the exporter or importer will undertake alternative arrangements required under the Regulations or will return the waste or material to the facility from which it was imported in accordance with s. 34 or 35. In the case of an export, import or transit, the insurance policy will cover the period speciﬁed by the Regulations and the information in the notice is complete and correct.
Name: Date:Tel. No.:
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