NEW JERSEY DEPARTMENT OF ENVIRONMENTAL PROTECTION-DIVISION OF
SOLID AND HAZARDOUS WASTE
SOLID WASTE ORIGIN AND DISPOSAL FORM
A. Transporter Section (To
be completed by the Transporter prior to transport to the disposal site)
1. Name of Registered Transporter: ____________________
Phone No. ___________ 2. NJDEP Registration No.:
3. Type of Transporter Registration: (Check
One) ____A-901 Licensed ____Registered self-generator ____Registration Exempt
4. Waste Self- Generated: (Check One) ____YES
5. Name of LESSOR if the solid waste vehicle is leased: ________________________________________________________
6. Decal No.
License Plate No.
Leased Ė Yes or No
|7. A. Waste Types
Cab or Single Unit
|ID 10 - ID 13 - ID 13C - ID 23
ID 25 - ID 27 - ID 27A - ID 27I
|B. Source Separated Recyclables: (Please
Paper / Corrugated / Glass / Metal / Plastics /Concrete / Asphalt / Wood
/ Yard Material
8. Transporter to complete waste origin information.
% of Total Load
|* Sending Facility: (If solid
waste is transported from a solid waste intermodal, transfer, or material
recovery facility, list the facility name in the Municipality column, ID
# in the County column and the State in which the sending facility is located
in the State column.)
9. Date Waste Collected: ________________
10. Transporterís Certification: I
CERTIFY THAT THE INFORMATION PROVIDED ON THIS FORM IS TRUE TO THE BEST OF MY
PRINT DRIVERíS NAME
- Disposal Destinations
11. Final Disposal Facility Name & State (Transporter Completes 11 &
12. Non Hazardous Manifest # or Bill of Lading # or Pull
Ticket #: ______________________________
13. In State weigh location (Weigh master completes 13 through 16): ______________________________________
14. GROSS WT.:___________ NET WT. (IN
STATE DISPOSAL ONLY):_______ 15.
SCALE TICKET No. (IN STATE
16. Weigh masterís Certification: I
CERTIFY THAT THIS FORM HAS BEEN COMPLETED BY THE REGISTERED TRANSPORTER IDENTIFIED
ABOVE, AND THAT THE GROSS WEIGHT FIGURE IS TRUE AND ACCURATE FOR LOADS GOING
OUT OF STATE.
- In State Disposal Facility Section (To
be completed by facility operator for loads disposed of in State only)
17. New Jersey Receiving Facility Operator Certification:
I CERTIFY THAT THIS FORM HAS BEEN COMPLETED BY THE
REGISTERED TRANSPORTER IDENTIFIED ABOVE, AND THAT THE WASTE AS IDENTIFIED BY
THE TRANSPORTER IS PERMITTED TO BE DISPOSED OF AT THIS FACILITY
Receiving Facility Permit or ID#.:
_____________DATE_____ TIME_____OPERATORíS STAMP OR SIGNATURE_____________
Instructions for completing
NJDEP Solid Waste Origin And Disposal Form
- Name of Registered Transporter and Phone Number:
The transporter must use the registered trade name of the transporter as identified
on the NJDEP Solid Waste Transporter Registration along with the appropriate
telephone number (including area code) of the company. Nicknames, aliases
and abbreviations are not acceptable.
- NJDEP registration No.: The correct NJDEP Solid Waste Transporter
Registration Number must be filled out. This number appears on the registration
certificate which must be carried with the vehicle.
- Type of Transporter Registration: The appropriate box must be checked
depending on whether the transporter is licensed, is a self generator exempted
from licensing requirements, or the vehicle is not subject to NJDEP registration
- Waste Self Generated: The appropriate box must be checked to disclose
whether the waste was self generated by the entity performing the transportation.
- Name of LESSOR if the solid waste vehicle is leased: The name of
the lessor as indicated on the lease must be filled in if the vehicle is leased.
The lease must be carried in the registered vehicle.
- Decal No., Type, License Plate No., Capacity, and Leased: The decal
number must be filled in for the appropriate type of registered equipment
(i.e. container, trailer, cab, etc.). The License plate must also be filled
in for the appropriate equipment along with the capacity (i.e. 30 cubic yard
container). Yes or No must be filled in next to the appropriate type of equipment
to indicate if it is leased.
- Waste Types and Source Separated Recyclables: The transporter must
indicate the type(s) of waste being transported by circling the appropriate
waste types. An example of "other" would be non hazardous bulk liquid
(type 72) for example. If a load consists of source separated recyclables
the transporter must circle the appropriate material. If the load consists
of more than one co-mingled type of recyclable, "co-mingled" must
be indicated under the "Other" section along with the approximate
percentages (i.e. co-mingled paper 25%, metal 50%, plastics 25%)
- Municipality, County State, % of Load: The transporter must identify
the waste origin by municipality, county, and state along with the respective
percentage of each waste origin. In the event waste is transported from one
solid waste facility to another (for example from a transfer station to a
landfill for disposal) the transporter must indicate the sending facilityís
name in the municipality column, the facility permit # in the County column,
and the State in which the sending facility is located in the State column,
in addition to the waste origin(s). The percentage of waste sent from a single
solid waste facility such as a transfer station should be recorded as 100%.
- Date Waste Collected: The transporter must fill in the actual date
the solid waste was collected.
- Transporterís Certification: The driver representing the transporter
must print and sign his/her name and date to certify the information in the
Transporter Section was completed accurately.
- Final Disposal Facility Name & State: The transporter must fill
in the final disposal facility name and State in which the facility is located.
- Non Hazardous Manifest # or Bill of Lading # or Pull Ticket #: The
transporter must identify the appropriate manifest or bill of lading number
for loads being transported for out of State disposal. The pull ticket number
must be recorded for all loads where such a document is generated.
- In State weigh location: The weigh master must complete the location
of the weighing facility. For most instances of in State disposal this is
the same location as the disposal facility, however in cases involving loads
being transported out of State, the weigh location may be designated to be
a location other than a disposal facility.
- Gross Wt. And Net Wt.: The weigh master must complete the
gross weight for all vehicles transporting waste and recyclables into solid
waste facilities within this State. The gross weight must also be completed
for all loads destined for out of State waste disposal facilities. The net
weight must be recorded for all loads being disposed of in this State.
- Scale ticket #. The weigh master must record the appropriate scale
ticket # generated for loads received for disposal within this State.
- Weigh masterís Certification: The weigh master must certify the information
he or she recorded is accurate.
- New Jersey Receiving Facility Operator Certification: The person
responsible for recording information for loads received at New Jersey solid
waste facilities must fill in the facility number the date and time and stamp
or sign the the form to certify the form was completed by the transporter
and that the waste identified by the transporter is permitted to be accepted
at the facility for disposal.
Failure to carefully follow these instructions in accurately completing the
Solid Waste Origin and Disposal Form can lead to enforcement action including
Waste Type ID 10 = municipal solid waste
Waste Type ID 13 = bulky solid waste
Waste Type ID 13C = construction & demolition debris
Waste Type ID 23 = vegetative waste
Waste Type ID 25 = animal and food processing waste
Waste Type ID 27 = dry industrial waste
Waste Type ID 27A = asbestos containing waste
Waste Type ID 27I = incinerator ash