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Duty of Care: Waste Transfer Note

(WMC2A Version 3, August 2011)

Please complete this form before you visit the Transfer Station(s)

Section B - Current Holder of the Waste - Transferor

By signing below I confirm that I have fulfilled my duty to apply the waste hierarchy as required by Regulation 12 of the Waste (England and Wales) Regulations 2011*

Yes

B1: Transferor's Full Name (for address where the waste originated)*

First Name

Last Name

Company Name

SIC (Standard Industrial Classification Code)

Phone*

Email*

Address*

Address Line 1

Address Line 2

City

County/Region

Postcode

Transferor's Signature (for address where the waste originated)*

[clear]

Use your mouse or finger to draw your signature above

B2: Name of your unitary authority or council*

B3: Are you:*

A registered waste carrier, broker or dealer? The producer of the waste? The local authority? The holder of an environmental permit? Registered waste exemption? None of above

Registration number if you are a registered waste carrier, broker or dealer*

The number starts with CBD__

Details (are you a carrier, broker or dealer?)*

Permit number of the Environmental Permit*

The environmental permit Issued by*

Details of waste exemption including registration number*

Section C - Person Collecting the Waste - Transferee

The same as transferor?*

Yes No

C1: Transferee's Full Name*

First Name

Last Name

Company Name*

Company Address*

Address Line 1

Address Line 2

City

County/Region

Postcode

C2 & 3: Are you: *

The local authority? The holder of an environmental permit? Registered waste exemption? A registered waste carrier, broker or dealer? None of above

Permit number of the Environmental Permit*

The environmental permit Issued by*

Details of waste exemption including registration number*

Registration number if you are a registered waste carrier, broker or dealer*

The number starts with CBD__

Details (are you a carrier, broker or dealer?)*

You must have a valid waste carriers licence to bring items to the site. If you do not you are risking being fined and having your vehicle seized. To apply visit: https://www.gov.uk/register-renew-waste-carrier-broker-dealer-england

Transferee's Signature (for the waste carrier)*

[clear]

Use your mouse or finger to draw your signature above

Section D - The Transfer

D1: Address of transfer or collection point*

Abbey Road Transfer Station, West London Waste Authority, Abbey Road, London, NW10 7TJ

A waste transfer note can be used for 1 load of waste on 1 day or for many loads over a period of time up to a year as long as the waste is coming from the same source and is the same type of material. Please read the information on the website for more details.

Day Valid From:*

Day Valid To:

Approx. Time of Transfer (only applicable if this transfer note is valid for one day)

Duty of Care: Waste Transfer Note

Section A - Description of Waste

Section B - Current Holder of the Waste - Transferor

Section C - Person Collecting the Waste - Transferee

Section D - The Transfer