Description and Volume of Rejected WastePMAMWaste Generation SiteLocation Time of Waste RejectionSignatureZIP CodeFacility NameStateCityAddressWHERE THE WASTE WAS FINALLY DISPOSEDEmail AddressZIP Co ID: 896099
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1 Reason for Rejection Description and Vol
Reason for Rejection Description and Volume of Rejected Waste P.M. A.M. Waste Generation Site/Location Time of Waste Rejection Signature ZIP Code Facility Name State City Address WHERE THE WASTE WAS FINALLY DISPOSED E-mail Address ZIP Code Facility Name State Telephone Number City Contact Name Address FACILITY REJECTING THE WASTE E-mail Address ZIP Code Telephone Number Company Name (Required) Contact Name State City Address WHERE WAS WASTE GENERATED? Driver Telephone Number Driver Name License Plate Number Vehicle Description WH- North Dakota Waste Hauler Permit Number E-mail Address Contact Name ZIP Code Telephone Number State City Company Name Mailing Address WASTE TRANSPORTER Date of Waste Rejection (Month/Day/Year) limited to: (a) waste containing materials not allowed for disposal, (b) transporters that do not have a valid North Dakota Solid Waste Transporter Permit, (c) waste that fell, spilled, or leaked from a transport vehicle, or (e) other reasons (unsuited/unsafe vehicles or vehicle operation, free liquids in loads, etc.). A signed copy of this form shall be provided to the Department at the above-noted address within 5 days 918 East Divide Avenue, 3rd FloorTelephone: 701-328-5166 WASTE REJECTION REPORTNORTH DAKOTA DEPARTMENT OF HEALTHDIVISION OF WASTE MANAGEMENT