Forms

THIRD PARTY SIGNATURE AUTHORIZATION FOR WASTE MANAGEMENT

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This authorization is only valid for 3 years from the date entered below.

To Whom It May Concern: Please be advised that the following company/individual has been appointed to work as our agent for purposes of managing waste materials that we may generate.

Date

Authorized Agent

Name of Authorized Agent

Title

Name of Company

Telephone Number

The above broker/individual is authorized to act as our authorized agent for the following purposes:

Complete and sign Special Waste Profile.
Complete and sign Special Waste Profile-Recertification.
Authorize amendments to Special Waste Profile.
Sign contracts to dispose and/or transport material.
Sign certifications necessary to comply with landfill requirements.
Sign manifests to initiate shipment to disposal facilities.

Our authorized agent will notify us prior to any action stated above, and will provide us with copies of any documents bearing our name.

Generator (Authorizing Party)

Name of Company

Mailing Address

Generator Contact (Print Name)

Title

Email

Signature

Telephone Number

Form revision: March 2022

Waste Profile Sheet