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2. 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:
4. Generates 1 kg (2.2 lbs) or less of acute hazardous waste in a calendar month
5. Generates 100 kg (220 lbs.) or less of non-acute hazardous waste in a calendar month
6. Accumulates 1000 kg (2200 lbs.) or less of non-acute hazardous waste at any given time
8. 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
10. 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.
12. 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.
16. CONTACT INFORMATION
18. First Name*
19. Last Name*
21. Email Address*
22. Phone Number*
23. Application Date*
    Application Date
27. BUSINESS INFORMATION
29. Business Name*
31. Physical Address*
33. City*
34. State*
35. Zip Code*
37. Billing Address the same as Physical Address?*

    1. Yes
    2. No

    If "No," please fill out the Billing Information below.
39. Billing Address
41. City
42. State
43. Zip Code
47. 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.
49. First Name*
50. Last Name*
51. Emergency Phone Number*
55. SBWP Generator Agreement*

    1. I agree to the SBWP Terms & Conditions

    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.
59. Thank You!

    After reviewing your SBWP Generator Certificate, HPC Staff will contact you as soon as possible to get a detailed list of your inventory, and to schedule an appointment. Have a good day.

Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit Submit and Print

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