BUSINESS DISPOSAL FORM
All information on this form is required for participation.
Company:
Address:
Street Location (no P.O. box please) City Zip
Type of Business:
Office Phone Number:
Owner/Mgr.
E-Mail Address:
Transport your waste in compliance with Department of Transportation regulations 49 CFR (www.dot.gov)
Collection sites reserve the right to refuse part or all of any waste load brought in for disposal.
Waste Type
Example:Waste Oil
Aerosols
Batteries (auto) Limit 5
Liquid Pesticides
Batteries (other than auto)
Oil-based paint
Solid Pesticides
Used paint thinner/solvent/gasoline
Waste oil
Write in other wastes
Original: King County LHWMP Copy: Customer
Please PRINT legibly and rmly – You are making multiple copies.
Staff Only: Waste Received by: Facility:
SS - FS - WMB - NS
Haz Waste Program Site Representative
Circle one WMB City
1903_9518E_Haz_Waste_Business_Disposal_Form_Online-Fillable.ai sk SQG-GEN-17(3/11)
Service Date:Total Weight:
Write in container/item size for each waste
x
(ex. auto repair, nail salon, small appliance repair)
Date__________________
items
items
pounds
gallons
gallons
gallons
pounds
quarts
quarts
quarts
gallons
quarts
gallons
quarts
How much?
Quantity/Amount (units)
(check one for each waste type)
3
Name:
Office use only
code quant. units
NOTICE: This program is for King County businesses only that generate less than 220 lbs (or 27 gal) of hazardous
waste monthly and less than 2.2 lbs. (1 qt) of certain Extremely Hazardous Wastes, and are Conditionally Exempt Small
Quantity Generators under Washington State Department of Ecology Dangerous Waste Regulations (WAC 173-303).
For details, visit www.kingcountyhazwastewa.gov or call our Hazardous Waste Help Line at 206-296-4692.
I certify, to the best of my knowledge, all of the information I entered on this form is correct.
Name of Driver: Vehicle License #:
Signature of Driver_____________________________________________
Businesses should retain a copy of this receipt for a minimum of 5 years as proof of disposal.
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