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E-Waste Management Record Form

This document outlines a form for maintaining records of electronic waste (e-waste) handled or generated. The form includes fields to track: 1) Contact information of the producer, manufacturer, refurbisher, dismantler, recycler, or bulk consumer. 2) Valid authorizations. 3) Types and quantities of e-waste handled, stored, collected, transported, refurbished, dismantled, recycled, and disposed of, including destinations. Notes specify which fields may not apply and to provide additional required information.

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2K views2 pages

E-Waste Management Record Form

This document outlines a form for maintaining records of electronic waste (e-waste) handled or generated. The form includes fields to track: 1) Contact information of the producer, manufacturer, refurbisher, dismantler, recycler, or bulk consumer. 2) Valid authorizations. 3) Types and quantities of e-waste handled, stored, collected, transported, refurbished, dismantled, recycled, and disposed of, including destinations. Notes specify which fields may not apply and to provide additional required information.

Uploaded by

mrugeshj
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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FORM-2

[See rules 4(4), 5(4), 6(5), 8(7), 9(2), 10(7), 11(8), 13 (1) (xi), 13(2)(v), 13(3)(vii) and
13 (4)(v)]

FORM FOR MAINTAINING RECORDS OF E-WASTE HANDLED OR GENERATED

Generated Quantity in Metric Tonnes (MT) per year


1. Name & Address:
Producer or
Manufacturer or
Refurbisher or
Dismantler or Recycler
or Bulk Consumer*
2. Date of Issue of
Extended Producer
Responsibility
Authorisation*/
Authorisation*
3. Validity of Extended
Producer Responsibility
Authorisation*/
Authorisation*
4. Types & Quantity of e- Category Quantity
waste handled or Item Description
generated**
5. Types & Quantity of Category Quantity
e-waste stored Item Description
6. Types & Quantity of Category Quantity
e-waste sent to Item Description
collection centre
authorised by producer/
dismantler/recycler /
refurbisher or authorised
dismantler/recycler or
refurbisher**
7. Types & Quantity of Category Quantity
e-waste transported* Quantity
Name, address and
contact details of the
destination
8. Types & Quantity of Category Quantity
e-waste refurbished* Item Description
Name, address and
contact details of the
destination of
refurbished materials
9. Types & Quantity of Category Quantity
e-waste dismantled* Item Description
Name, address and
contact details of the
destination

34
10. Types & Quantity of Category Quantity
e-waste recycled*
Types & Quantity of Item Description
materials recovered Quantity
Name, address and
contact details of the
destination
11. Types & Quantity of e- Category Quantity
waste sent to recyclers Item Description
by dismantlers
Name, address and
contact details of the
destination
12. Types & Quantity of Category Quantity
other waste sent to
respective recyclers by Item Description
dismantlers/recyclers of
e-waste
Name, address and
contact details of the
destination
13. Types & Quantity of Category Quantity
e-waste treated & Item Description
disposed
Name, address and
contact details of the
destination

Note:-

(1) * Strike off whichever is not applicable

(2) Provide any other information as stipulated in the conditions to the authoriser

(3) ** For producers this information has to be provided state-wise

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