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PTT Application Form

The document is an application form for a local transport permit of hazardous waste. It requests information on the waste generator, transporter, treater/recycler, as well as details on the hazardous waste to be transported such as type, quantity, and intended treatment process. Applicants must provide attachments including a service agreement between involved parties, a transport management plan, and copies of relevant registration certificates. Upon completion, the application requires a signature and notarization.

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415 views2 pages

PTT Application Form

The document is an application form for a local transport permit of hazardous waste. It requests information on the waste generator, transporter, treater/recycler, as well as details on the hazardous waste to be transported such as type, quantity, and intended treatment process. Applicants must provide attachments including a service agreement between involved parties, a transport management plan, and copies of relevant registration certificates. Upon completion, the application requires a signature and notarization.

Uploaded by

jovet.pizarra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Republic of the Philippines

DEPARTMENT OF ENVIRONMENTAL AND NATURAL RESOURCES


ENVIRONMENTAL MANAGEMENT BUREAU
CALABARZON Region
6th Flr. DENR by the Bay Bldg., 1515 Roxas Blvd., Ermita, Manila 1000
RD’s Office: 536-3095; 536-2808; Telefax No. 536-9784; administrative Division Telefax No. 404-1610
EQ Division 525-0348/404-3974; EIA Division Telefax No. 522-8177

LOCAL TRANSPORT OF HAZARDOUZ WASTE


Transport Permit Application Form
I. Information on the Waste Treater/Recycler

Name

Office Address

Facility Address

Tel. No.: Fax No.:

TSD Registration No. Date of Validity:

ECC No.: Date of Issuance:

II. Information on the Waste Generator (if more than One [1], use another sheet)

Name

Address

DENR ID No.

Tel. No.: Fax No.:

III. Information on the Waste Transporter

Name

Address

Tel. No.: Fax No.:

Transporter Registration No. Date of Validity:

IV. Information on the Waste to be Transported and Treated:

No. Hazardous Waste Type of Waste Quantity Treatment Process


No.
1
2
3
4
5
V. Attachments: (New)

a)Notarized Memorandum or Service Agreement (TSD, generator and transporter)


b)Transport Management Plan to include schedule and route of transport
c)Copy of the most recent Self Monitoring Report of the Waste Generator officially submitted
d)Copies of the Generator,Transporter and TSD Registration Certificates
I certify that the above information are true and correct.

__________________________________
Name and Position of Applicant

Signature: Date:

SUBSCRIBED AND SWORN before me, a Notary Public this _____day of __________________, 2013,
Affiant exhibiting to me his/her Community Tax Receipt No. ______________issued on ______________
at ___________________.

NOTARY PUBLIC
Permit Fee Amount: OR#: Date:
DST Fee Amount: OR#: Date:

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