Form R-5211 Hw Schedule A Hazardous Waste Generated And Disposed/stored At Same Site
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1R-5211 (7/07)
Page ______ of ______
HW SCHEDULE A
Hazardous Waste Generated and
Disposed/Stored at Same Site
Report hazardous waste generated and disposed or stored
over 90 days for disposal at the same site as generated.
PLEASE PRINT OR TYPE.
Name
LA Revenue Account Number
Quarter Ending (MM/DD/YYYY)
a
b
c
d
e
f
g
Total Tons Disposed/
Exempt
Stored over 90 Days
Disposals
Taxable Wet Weight
Dry Weight
Taxable
Description of Waste
(Wet Weight)
(Wet Weight)
Method of Exempt Disposal
(Column b less Column c)
Factor
Dry Weight
TOTALS
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Parent category: Financial