Form B : Registration form for HW Treatment Storage and Disposal (TSD) Facility

Section B1: Company Profile

Type of Application: □New Registration □Renewal □Amendment
Payment O.R. No.: TSD ID:
Name of Establishment:
FacilityAddress:
Region: Province Code:
Tel.: Fax: E-mail:
Managing Head:
Pollution Control Officer (PCO):
PCO Tel.: PCO E-mail:
PCO Accreditation No.: Date of Accreditation:
Date of Establishment: SEC/DTI Registration No.:
Total Number of Employees:
ECC Number:
Permit to Operate Number: Valid until:
Discharge Permit Number: Valid until:
Section B2: TSD Profile
TSD Treatment Residual Waste
Treatment Method Treatment Description
Category Capacity Management

HW Treated:

HW Treated:

HW Treated:

I certify that enclosed information is a true and accurate record as available.

Name of Preparer: Position:

Signature: Date:

Form B ver.2018