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SBWP Generator Certification Form

  1. SMALL BUSINESS WASTE PROGRAM GENERATOR TERMS & CONDITIONS

    I hereby certify that the business listed below meets the criteria to qualify as a Very Small Quantity Generator (VSQG) as per the following regulations of EPA 40 CFR 262.14:

  2. Generates 1 kg (2.2 lbs) or less of acute hazardous waste in a calendar month

  3. Generates 100 kg (220 lbs.) or less of non-acute hazardous waste in a calendar month

  4. Accumulates 1000 kg (2200 lbs.) or less of non-acute hazardous waste at any given time

  5. I understand that my business may only participate in the Hazardous Products Center's (HPC) Small Business Waste Program (SBWP) only if they qualify as a VSQG and are located within Coconino County. I also understand that if my generator status changes from a VSQG, or if my business surpasses any of the limits stated above, I may no longer participate in the SBWP

  6. I agree that the contents of the waste inventory being brought to the HPC, will be categorized, segregated, packed, marked, labeled and are in all respects, in proper condition for transport by highway according to the applicable regulations of the Department of Transportation.

  7. I have reviewed the SBWP Guidelines and understand that there will be costs associated with the disposal of my business waste, and that any adjustments and final billing will be determined upon completion of waste processing by HPC facility Staff. I acknowledge that a copy of this document and any supporting paperwork will be kept in my businesses SBWP folders for regulatory review and hazardous compliance monitoring for a minimum of 3 years.

  8. CONTACT INFORMATION

  9. BUSINESS INFORMATION

  10. Billing Address the same as Physical Address?*

    If "No," please fill out the Billing Information below.

  11. 24-HOUR EMERGENCY CONTACT INFORMATION

    In the event an emergency occurs before, during, or after your appointment, an emergency contact person and phone number are required for immediate assistance or verification.

  12. SBWP Generator Agreement*

    By agreeing to this form, I certify that I have the authority to make the above statements on behalf of my business, organization, and/or firm and all information given is true and accurate to my knowledge.

  13. Leave This Blank:

  14. This field is not part of the form submission.