Form R-5212 Hw Schedule B Hazardous Waste Generated And Disposed/stored At Another Site
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1R-5212 (7/07)
Page ______ of ______
HW SCHEDULE B
Hazardous Waste Generated and
Disposed/Stored at Another Site
Report hazardous waste generated and disposed or
stored over 90 days for disposal at another site.
PLEASE PRINT OR TYPE.
Name
LA Revenue Account Number
Quarter Ending(MM/DD/YYYY)
a
b
c
d
e
f
Total Tons
Disposed/Stored Over
Exempt Disposal
Taxable Wet Weight
Dry
(Column b less
Weight
Taxable
90 Days
Including Out-of-State
Description of Waste
(Wet Weight)
(Wet Weight)
Column c)
Factor
Dry Weight
TOTALS
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Parent category: Financial