Newfoundland and Labrador - Collector registration application form

Collector registration application form

Newfoundland & Labrador
******* IMPORTANT NOTICE ******

Before completing the collectors registration application form, please make sure you have completed, signed and initialed each page of the Collectors Agreement and that you have the following documents in PDF format: the initialed Collectors Agreement, your Civil and Environment Insurance Certificate and Government issued Operation permit(s) (if applicable). All above mentioned documents must be attached to the following collectors registration form.
Company legal name:
Address

Street address

Street address (line 2)

City Province/State

Postal/Zip Code
Telephone

Area CodePhone #
Extension

Contact Person
Title
Contact person email address

Confirmation EmailConfirm contact person's email Address
Contact person for RI claims (if different)
Email address for RI claims contact person (if different)

Confirmation EmailConfirm email address for RI claims contact person

Where are your storage facilities located? (select all that applies)

Please indicate the address of your hazardous waste storage facility(ies) in Newfoundland & Labrador where will be stored Atlantic Used Oil Management Association (Newfoundland & Labrador) products.
Do you have a permit or certificate for your Newfoundland & Labrador facility(ies) where you store products for which you are registering with Atlantic Used Oil Management Association (Newfoundland & Labrador)?
Attach your government issued permit(s) or certificate(s) for every facility(ies) where will to stored Atlantic Used Oil Management Association (Newfoundland & Labrador) products

Attach your file(s)
You can attach more than one file Cancelof
Are you required to produce a report to the government authority having jurisdiction in Newfoundland and Labrador for your hazardous waste storage facility(ies) in Newfoundland & Labrador?
Specify which type(s) of report(s), for which facility(ies), and the frequency at which you are required to produce such report(s).

Please indicate the address of every hazardous waste storage facility(ies) outside of Newfoundland & Labrador where you will store Atlantic Used Oil Management Association (Newfoundland & Labrador) products.
For every facility(ies) outisde of Newfoundland & Labrador, briefly explain what are the province or state requirements in order to collect/store the products for which you are registering with Atlantic Used Oil Management Association (Newfoundland & Labrador).
Do you have a permit or certificate for your facility(ies) outside of Newfoundland & Labrador where you store products for which you are registering with Atlantic Used Oil Management Association (Newfoundland & Labrador)?
Attach your government issued permit(s) or certificate(s) for every facility(ies) where you intend to store Atlantic Used Oil Management Association (Newfoundland & Labrador) products.

Attach your file(s)
You can attach more than one file Cancelof
Are you required to produce a report to local government authorities for your hazardous waste storage facility(ies) outside of Newfoundland & Labrador?
Specify which type(s) of report(s), for which facility(ies), and the frequency at which you are required to produce such report(s).

Briefly describe your current spill prevention and containment measures (e.g. berm(s) or other confinement unit(s), regular inspections of storage units, proximity of absorbants, etc.)
When was your last inspection by the government authority having jurisdiction in Newfoundland and Labrador (or the equivalent government authority if you are located outside the province of Newfoundland & Labrador) concerning the activities for which you are registering with Atlantic Used Oil Management Association (Newfoundland & Labrador)? Specify the location of the inspected facility(ies), the month and year of inspection.
Over the last two years, has your company received an infraction notice from the government authority having jurisdiction in Newfoundland and Labrador (or the equivalent government autority if you are located outside of Newfoundland & Labrador) regarding a facility whose activities are related to Atlantic Used Oil Management Association (Newfoundland & Labrador) products?
Attach a copy of your infraction notice.

Attach your file(s)
You can attach more than one file Cancelof
For each infraction notice your company has received, briefly explain what measures were implemented to correct the situation.

Please select the zones in which you collect our products

Collector's Agreement signed and initialized on every page

Attach your file

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Civil and environmental insurance certificate.

Attach your file(s)
You can attach more than one file Cancelof

Which of the following products do you wish to register as a Atlantic Used Oil Management Association (Newfoundland & Labrador) collector for?

Collection of USED OILS: Estimated annual volume (in L)
How long has your company been collecting USED OILS?
List the address of each facility where you store USED OILS and specify the maximum storage capacity for each facility.
How many tanks does your company have to store collected USED OILS? Indicate the capacity for each one.
How many trucks does your company have to collect USED OILS?
For each of your trucks collecting USED OILS, provide the following information:
What are steps of your collection process and how do you keep track of the USED OILS quantities collected at each generators location?
Do you exercise quality control of the USED OILS collected?
Briefly explain your quality control procedures for the USED OILS collected.
Are USED OILS analysis performed by an accredited laboratory? (Atlantic Used Oil Management Association (Newfoundland & Labrador) requires analysis performed by accredited laboratory).
Where do you dispose of oily water?
Indicate the name of the establishment where you dispose of your oily water.
Products applicable to Atlantic Used Oil Management Association (Newfoundland & Labrador)'s program originating from other provinces are NON-Atlantic Used Oil Management Association (Newfoundland & Labrador) products.
Are you collecting USED OILS applicable to Atlantic Used Oil Management Association (Newfoundland & Labrador)'s program in other provinces than Newfoundland & Labrador?
What control will you implement in order to determine what qualifies as Atlantic Used Oil Management Association (Newfoundland & Labrador) and NON-Atlantic Used Oil Management Association (Newfoundland & Labrador) products amongst the quantities collected?
You will need that information in order to complete your collector claim forms and to complete your Atlantic Used Oil Management Association (Newfoundland & Labrador) annual statement.

Collection of USED ANTIFREEZE: Estimated annual volume (in L)
How long has your company been collecting USED ANTIFREEZE?
List the address of each facility where you store USED ANTIFREEZE and specify the maximum storage capacity for each facility.
How many tanks does your company have to store collected USED ANTIFREEZE? Indicate the capacity for each one.
How many trucks does your company have to collect USED ANTIFREEZE?
For each of your trucks collecting USED ANTIFREEZE, provide the following information:
What are steps of your collection process and how do you keep track of the USED ANTIFREEZE quantities collected at each generators location?
Do you exercise quality control of the USED ANTIFREEZE collected?
What are steps of your collection process and how do you keep track of the USED ANTIFREEZE quantities collected at each generators location?
Do your truck drivers use a refractometer at every collection?
Products applicable to Atlantic Used Oil Management Association (Newfoundland & Labrador)'s program originating from other provinces are NON-Atlantic Used Oil Management Association (Newfoundland & Labrador) products.
Are you collecting USED ANTIFREEZES applicable to Atlantic Used Oil Management Association (Newfoundland & Labrador)'s program in other provinces than Newfoundland & Labrador?
What control will you implement in order to determine what qualifies as Atlantic Used Oil Management Association (Newfoundland & Labrador) and NON-Atlantic Used Oil Management Association (Newfoundland & Labrador) products amongst the quantities collected?
You will need that information in order to complete your collector claim forms and to complete your Atlantic Used Oil Management Association (Newfoundland & Labrador) annual statement.

Collection of USED FILTERS: Estimated annual volume (in kg)
How long has your company been collecting USED FILTERS?
List the address of each facility where you store USED FILTERS and specify the maximum storage capacity for each facility.
How many trucks does your company have to collect USED FILTERS?
For each of your trucks collecting USED FILTERS, provide the following information:
What are steps of your collection process and how do you keep track of the USED FILTERS quantities collected at each generators location?
What type of containers do you collect at your generator's location for USED FILTERS? (select all that applies)

Other
Do you have a scale to weigh the USED FILTERS containers you've collected?
When was your last weighing scale calibration?
Indicate the date (YYYY-MM-DD )
Products applicable to Atlantic Used Oil Management Association (Newfoundland & Labrador)'s program originating from other provinces are NON-Atlantic Used Oil Management Association (Newfoundland & Labrador) products.
Are you collecting USED FILTERS applicable to Atlantic Used Oil Management Association (Newfoundland & Labrador)'s program in other provinces than Newfoundland & Labrador?
What control will you implement in order to determine what qualifies as Atlantic Used Oil Management Association (Newfoundland & Labrador) and NON-Atlantic Used Oil Management Association (Newfoundland & Labrador) products amongst the quantities collected?
You will need that information in order to complete your collector claim forms and to complete your Atlantic Used Oil Management Association (Newfoundland & Labrador) annual statement.

Collection of USED OIL AND ANTIFREEZE CONTAINERS: Estimated annual volume (in kg)
How long has your company been collecting USED OIL AND ANTIFREEZE CONTAINERS?
List the address of each facility where you store USED OIL AND ANTIFREEZE CONTAINERS and specify the maximum storage capacity for each facility.
How many trucks does your company have to collect USED OIL AND ANTIFREEZE CONTAINERS?
For each of your trucks collecting USED OIL AND ANTIFREEZE CONTAINERS, provide the following information:
What are steps of your collection process and how do you keep track of the USED OIL AND ANTIFREEZE CONTAINERS quantities collected at each generators location?
What type of containers do you collect at your generator's location for USED OIL AND ANTIFREEZE CONTAINERS? (select all that applies)

Other
Do you have a scale to weigh the USED OIL AND ANTIFREEZE CONTAINERS containers you've collected?
When was your last weighing scale calibration?
Indicate the date (YYYY-MM-DD )
Products applicable to Atlantic Used Oil Management Association (Newfoundland & Labrador)'s program originating from other provinces are NON-Atlantic Used Oil Management Association (Newfoundland & Labrador) products.
Are you collecting USED OIL AND ANTIFREEZE CONTAINERS applicable to Atlantic Used Oil Management Association (Newfoundland & Labrador)'s program in other provinces than Newfoundland & Labrador?
What control will you implement in order to determine what qualifies as Atlantic Used Oil Management Association (Newfoundland & Labrador) and NON-Atlantic Used Oil Management Association (Newfoundland & Labrador) products amongst the quantities collected?
You will need that information in order to complete your collector claim forms and to complete your Atlantic Used Oil Management Association (Newfoundland & Labrador) annual statement.

Collection of USED AEROSOL CONTAINERS (lubricants and brake cleaners only): Estimated annual volume (in kg)
How long has your company been collecting USED AEROSOL CONTAINERS (lubricants and brake cleaners only)?
List the address of each facility where you store USED AEROSOL CONTAINERS (lubricants and brake cleaners only) and specify the maximum storage capacity for each facility.
How many trucks does your company have to collect USED AEROSOL CONTAINERS (lubricants and brake cleaners only)
For each of your trucks collecting USED AEROSOL CONTAINERS (lubricants and brake cleaners only), provide the following information:
What are steps of your collection process and how do you keep track of the USED AEROSOL CONTAINERS (lubricants and brake cleaners only) quantities collected at each generators location?
What type of containers do you collect at your generator's location for USED AEROSOL CONTAINERS (lubricants and brake cleaners only)? (select all that applies)

Other
Do you have a scale to weigh the USED AEROSOL CONTAINERS (lubricants and brake cleaners only) containers you've collected?
When was your last weighing scale calibration?
Indicate the date (YYYY-MM-DD)
Products applicable to Atlantic Used Oil Management Association (Newfoundland & Labrador)'s program originating from other provinces are NON-Atlantic Used Oil Management Association (Newfoundland & Labrador) products.
Are you collecting USED AEROSOL CONTAINERS applicable to Atlantic Used Oil Management Association (Newfoundland & Labrador)'s program in other provinces than Newfoundland & Labrador
What control will you implement in order to determine what qualifies as Atlantic Used Oil Management Association (Newfoundland & Labrador) and NON-Atlantic Used Oil Management Association (Newfoundland & Labrador) products amongst the quantities collected?
You will need that information in order to complete your collector claim forms and to complete your Atlantic Used Oil Management Association (Newfoundland & Labrador) annual statement.

What method will you use to proceed with the payment of the registration renewal fee ($200 plus taxes)?
Would you like to receive payments by cheque or electronic funds transfer (EFT)?
Please attach a void cheque in order to get EFT

Attach your file

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Signatory Name
Signatory title
I, {signatoryName}, {signatoryTitle}, declare I am duly authorized for this purpose and certify that the information provided on this form is accurate.
Signature
Signature
Date

an MoisJour
4 digit year, 2 digit month, 2 digit dayDate
Should be Empty: