Annual Compliance Verification Form
Please complete the information below to verify your annual compliance for hazardous waste reporting. This information will be used to prepare your California DTSC Electronic Verification Questionnaire (eVQ).
Has anything changed since your last filing? (select all that apply)
*
No changes
Business Name
Facility Address
Mailing Address
Ownership
Contact Person
Phone / Email
If changes occurred, please explain
eVQ username
If known
eVQ password
If known
Number of California Employees
*
Hazardous waste manifests for the reporting year
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of
Name of hazardous waste transporter (if manifests not available)
Printed Name
*
Title
*
Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Verification
Submit Verification
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