Waste Tracking Form - Broward County
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1Waste Tracking Form
__________
for EPGMD Decal Number
to the Broward County, Septage Receiving Facility
Hauler: ____________________________________
Account Number
Permit Number______________
Pick up
Waste Pick up Location
Waste Class
Estimated
Date
Name/ Address/Phone Number
Type of Waste
Volume
(Gal.)
□
□
1.
Business
Residence
□
□
2.
Business
Residence
□
□
3.
Business
Residence
□
□
4.
Business
Residence
□
□
□
□
Waste origin:
Dade
Broward
Palm Beach
Other
____________________
□
□
Vehicle cleaning needed? Yes
No
□
□
Transporting liquid waste? Yes
No
I certify that the information listed here is true, accurate and complete.
Driver Name ___
________
Signature _________________________________
To be completed by Septage Receiving Facility Operator:
Date _____
Time __
Ticket #______
Initials ________________
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Parent category: Business