Hazardous waste and recyclable material: confirmation of disposal or recycling

Confirmation of Disposal or Recycling

Attention:      

Waste Reduction and Management Division
Environment Canada
14th Floor, Place Vincent Massey
351 St. Joseph Blvd.
Gatineau QC  K1A 0H3

As required under Part 6, paragraphs 36(1)(a)(b)(c), and subsections 36(2), and 36(3) of the Export and Import of Hazardous Waste and Hazardous Recyclable Material Regulations, this certificate is provided as a confirmation of disposal or recycling.

The authorized facility where final disposal or recycling took place:

Name

Site address

City & Province/Territory

State & Country, ZIP/Postal Code

List includes all hazardous waste(s), or hazardous recyclable material(s), that have been disposed of, or recycled, by the disposal and/or recycling operation(s)
Movement document Notice (found on permit) Date of operation Method of disposal
or recycling
Quantity
Reference
Number
Line
#
Reference
Number
Line
#
(dd/mm/yyyy) (i.e. D3, R4) (kg or l)

I hereby confirm that the hazardous waste(s), or hazardous recyclable material(s), listed herein have been disposed of, or recycled, as intended in the specified notice(s). I certify that the information provided with respect to Part 6, subsection 36(2) to the Export and Import of Hazardous Waste and Hazardous Recyclable Material Regulations is accurate and complete.

Printed Name

Title

Email

Phone

Fax

 

______________________________
Signature of authorized responsible
company representative

 

_____________________________
Date

 

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