All new registration require a $100 intial fee. Registrations without this fee will not be processed. The fee is not required if only updating information to an existing and active registration
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MISSOURI DEPARTMENT OF NATURAL RESOURCES
HAZARDOUS WASTE PROGRAM
P.O.BOX 176               OR               1730 E ELM
JEFFERSON CITY, MO 65102          JEFFERSON CITY, MO 65101
(573) 751-3176
NOTE: $100 fee for new registration and reactivating registrations
FORM MUST BE
COMPLETE IN ITS
ENTIRETY, OR IT WILL
BE RETURNED.
NOTIFICATION OF REGULATED WASTE ACTIVITY Help Page
I. Type of Notification
Effective Date of Temporary ID
EPA #
MO #
II. Name of Installation (Business Name, Site Name or d.b.a.)
III. Location of Installation(Physical Address or directional description not P.O. Box or Route Number)
Street
City or Town State Zip Code
MO
-
IV. Installation Mailing Address (All correspondence will be sent to this address)
Street or P.O. Box
City or Town ZIP Code
-
V. Installation Contact (Person to be contacted regarding waste activities at the site)
Name (last) (first)
Email Address
Phone Number (area code and number) Extension
- -
VI. Ownership (Make copies of this section for multiple ownership)
A. Name of Installation's Legal Owner (Business Owner)
Street, P.O. Box, or Route Number
City or Town ZIP Code
-
Phone Number Extension B. Change of Installation Owner
- -
Date of Change
C. Installation owner type (Mark one)
D. Name of Property's Legal Owner
Street, P.O. Box, or Route Number
City or Town ZIP Code
-
Phone Number Extension E. Change of Property Owner
- -
Date of Change
C. Property owner type (Mark one)
MO 780-1164 (1-08) Previous edition is obsolete.