NEW WASTE ACCEPTANCE CERTIFICATE

Issued by waste facility confirming acceptance of waste from site

Linked Waste Transfer Note Reference

Optional — enter the WTN reference number this certificate relates to

1Waste Facility Details (Issuer)

Facility Name *

Contact Name

Facility Address *

Postcode

Telephone

Environmental Permit Number

EPR or waste management licence number

Permit Issued By

2Waste Producer / Site Details

Company / Organisation Name *

Contact Name

Site Address

Postcode

3Description of Waste

Waste Description *

EWC / LoW Codes

European Waste Catalogue codes — separate multiple codes with commas

Quantity *

Unit

Containment / Packaging

Loose

Sacks

Skip

Drum

IBC

Baled

Other

4Acceptance Decision

Waste accepted in full

Conditional acceptance (see conditions below)

Waste rejected — not accepted

5Disposal / Recovery Route

Disposal / Recovery Method

Disposal Site Address

If different from this facility

6Dates & Signatures

Date Received *

Time Received

Certificate Date *

Facility Representative — Signed Name

Producer / Site Representative — Signed Name

Additional Notes