A-314 Hazardous Waste Receiver Registration Form

Hazardous Waste Receiver Registration Form-Section 1-2

Instruction

The following information must be provided in order to register as a hazardous waste receiver in Nunavut and to obtain a receiver number. Incomplete applications will be returned to the applicant.
A receiver who operates a commercial business for the purpose of collecting, storing, transferring, treating, recycling or disposing of hazardous waste may be required to register the facility as a hazardous waste management facility. Refer to section 3.2.2 of the Environmental Guideline for the General Management of Hazardous Waste for further information.
Completed registration forms are to be forwarded to the Manager of Pollution Control, Department of Environment, Government of Nunavut, Box 1000, Station 1360, Iqaluit, Nunavut, X0A 0H0. Electronic registration forms are preferred and may be forwarded to [email protected].
Use additional pages to provide information as required.
Applicants should refer to the accompanying users’ guide for further assistance on completing the receiver registration form.

Receiver (Legal Name)

Mailing Address

Principal Contact Person

Title, Phone Number and Email Address

Alternate Contact Person

Title, Phone Number and Email Address

(provide a seperate table if required)

Site Location(s) where Waste is Received

Description of Waste Received

Shipping Name	TDG Number	TDG Class	Quantity Received each Month (L or Kg.)	Frequecy of Acceptance
Name	TDG Number	TDG Class	Quantity	Frequency
Name	TDG Number	TDG Class	Quantity	Frequency
Name	TDG Number	TDG Class	Quantity	Frequency
Name	TDG Number	TDG Class	Quantity	Frequency
Name	TDG Number	TDG Class	Quantity	Frequency
Name	TDG Number	TDG Class	Quantity	Frequency
Name	TDG Number	TDG Class	Quantity	Frequency

Steps