Washington Administrative Code
Title 173 - Ecology, Department of (See also Titles 197, 317, 372, and 508)
Chapter 173-303 - Dangerous waste regulations
Section 173-303-9906 - Special waste bill of lading

1)

Receiving Facility Name:

phone:

Address:

fax:

2)

Customer Name:

phone:

Address:

fax:

3)

Property Owner Name

(where waste originated):

phone:

Address:

fax:

4)

Hauler Name:

phone:

Address:

fax:

5)

Consultant Name:

phone:

Address:

fax:

6)

Amount of waste:

7)

Original Location of Special Waste:

8)

Activity Which Generated Waste:

9)

Description of Waste. Include any Applicable Dangerous Waste Code:

10)

Does Waste Have Potential to Create Fugitive Dust?

Yes

No

If Yes, What is your Plan to Mitigate Dust?

11)

Amount of wastes in pounds or tons:

SPECIAL WASTE WASTE ANALYSIS

Customer Must Initial the Appropriate Item.

1.

Wastes were designated through testing

2.

Wastes were designated by other means

Customer Certifies That:

1.

The Waste sampled and intended for disposal under this Certification is special waste as defined in WAC 173-303-040.

2.

The Waste has no free liquids per WAC 173-303-110(3)(c)(i).

Signature

Date