This archived regulation consolidation is current to December 3, 2004 and includes changes enacted and in force by that date. For the most current information, click here.

Schedule 5

Form 3 (s. 47)

[en. B.C. Reg. 132/92, s. 37; am. B.C. Reg 109/2002, s.1.]

CREST

  

PROVINCE OF BRITISH COLUMBIA

MINISTRY OF WATER, LAND AND AIR PROTECTION 

MANIFEST SUPPLEMENT — MULTIPLE CONSIGNORS

Instructions: The Carrier shall (a) complete this form;

(b) keep this form with the manifest;

(c) when the shipment has been completed:
Attach Copy A to Copy 1 of Manifest and mail to the appropriate authority in the jurisdiction where consignor is located
Attach Copy B to Copy 2 of Manifest and retain
Attach Copy C to Copy 5 of Manifest and deliver to consignee

Collection Point Information: 

Waste Name: .............................. Reference Manifest No.: ..............................

TDG Classification ..............................

TDG Product Identification No. (PIN) ..............................

 

Name

Address

City

Postal Code

Telephone

Consignor
Identification
Number

Consignor's
Signature

Quantity
kg or L

Cumulative
Total

kg or L

1. 

 

 

 

 

 

 

 

 

2.

 

 

 

 

 

 

 

 

3.

 

 

 

 

 

 

 

 

4.

 

 

 

 

 

 

 

 

5.

 

 

 

 

 

 

  

 

6.

 

 

 

 

 

 

 

 

7.

 

 

 

 

 

 

 

  

8.

 

 

 

 

 

 

 

 

9.

 

 

 

 

 

 

 

 

10.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total:

 

Carrier's Name (Please Print): ..........................................   Vehicle Licence Plate No. ..............................

Date:.............................(Y/M/D)   Driver's Name: ..............................(Please Print)

Driver's Signature ...........................................

Copyright (c) 2004: Queen's Printer, Victoria, British Columbia, Canada