Administrative Notice Form

Administrative form for proposed movements of hazardous wastes or hazardous recyclable materials

Notice

1. Option
Indicate the option that applies to this notice.


2. Exporter or Foreign Exporter

















3. Foreign Receiver or Importer
















4. Authorized Carrier







Modes of Transport:


If other authorized carriers used, attach a list.












5. Authorized Facility
(If operation D13, D14, D17, R12, R13, R16)

















Shipping Details





8. First and Last Shipments:





9. Transit Country(ies)



10. Hazardous Information

(For additional hazardous information please see Appendix to the Notice.)

International Waste Identification Code (IWIC)Basel Annex VIII or
OECD App. 4 Code
TDGR
PIN
ClassQuantityPacking / Risk Group


Customs CodeID No. & Description of Sch. 3-7POP name, quant. & conc.Description(s) of the
D/R process(es) to be used

 

International Waste Identification Code (IWIC)Basel Annex VIII or
OECD App. 4 Code
TDGR
PIN
ClassQuantityPacking / Risk Group


Customs CodeID No. & Description of Sch. 3-7POP name, quant. & conc.Description(s) of the
D/R process(es) to be used



International Waste Identification Code (IWIC)Basel Annex VIII or
OECD App. 4 Code
TDGR
PIN
ClassQuantityPacking / Risk Group


Customs CodeID No. & Description of Sch. 3-7POP name, quant. & conc.Description(s) of the
D/R process(es) to be used



International Waste Identification Code (IWIC)Basel Annex VIII or
OECD App. 4 Code
TDGR
PIN
ClassQuantityPacking / Risk Group


Customs CodeID No. & Description of Sch. 3-7POP name, quant. & conc.Description(s) of the
D/R process(es) to be used



International Waste Identification Code (IWIC)Basel Annex VIII or
OECD App. 4 Code
TDGR
PIN
ClassQuantityPacking / Risk Group


Customs CodeID No. & Description of Sch. 3-7POP name, quant. & conc.Description(s) of the
D/R process(es) to be used



International Waste Identification Code (IWIC)Basel Annex VIII or
OECD App. 4 Code
TDGR
PIN
ClassQuantityPacking / Risk Group


Customs CodeID No. & Description of Sch. 3-7POP name, quant. & conc.Description(s) of the
D/R process(es) to be used



International Waste Identification Code (IWIC)Basel Annex VIII or
OECD App. 4 Code
TDGR
PIN
ClassQuantityPacking / Risk Group


Customs CodeID No. & Description of Sch. 3-7POP name, quant. & conc.Description(s) of the
D/R process(es) to be used



International Waste Identification Code (IWIC)Basel Annex VIII or
OECD App. 4 Code
TDGR
PIN
ClassQuantityPacking / Risk Group


Customs CodeID No. & Description of Sch. 3-7POP name, quant. & conc.Description(s) of the
D/R process(es) to be used


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.








 

______________________________
Signature  

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