Hazardous waste licensing step 1

Information about you

First name (required) Last name (required) Job title (required)

Do not use special characters ($, &, #).

Phone (required)

Format as xxx-xxx-xxxx.

Email (required) Confirm email (required) Company name (required)

Do not use special characters ($, &, #).

Mailing address (required)

Include suite number, if applicable.

City (required) State (required) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip (required) Identify the first and last name of the Hennepin County Environment and Energy staff that you have been working with (required)

Write “unknown” if you're not sure or "not applicable" if you have not been working with any staff.

Information about the company

Company name (doing business as) (required)

Do not use special characters ($, &, #).

Parent company ownership name, if applicable

Do not use special characters ($, &, #).

Site address (required)

Include suite number, if applicable.

City (required) State (required) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip (required) What services does this site offer? Check all that apply (required) Auto body Construction trades Dry cleaning Equipment and tool maintenance and repair Health care: Dental clinic Health care: Long-term care facility Health care: Medical clinic Health care: Pharmacy Health care: Veterinary clinic Machining and manufacturing Metal finishing Painting Printing Property services, property maintenance and landscaping services Retail Transportation services Vehicle repair Other Describe the business's principal products or services (required)

Character limit is 512.

Hours and days of operation (required)

Character limit is 512.

Sewer system (required) This business is connected to the city sewer system This business is connected to a septic system Other If other, describe

Character limit is 512.

Date the company began operating at this address (required) Describe your relationship with this company (required)

Hazardous Waste Identification Number (HWID)

HWID is also sometimes referred to as EPA ID number.

Does the company have a HWID? (required) Yes No I don't know If you know the company's HWID, provide that number here

• Research an HWID number.
• Apply for an HWID number (PDF).

Mailing contact

Mail contact first name (required) Mail contact last name (required) Job title (required)

Do not use special characters ($, &, #).

Phone number (required)

Format as xxx-xxx-xxxx.

Email (required) Confirm email (required) Address (required)

Include suite number, if applicable.

City (required) State (required) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip (required) Company mailing name (required)

Please complete even if you are the mailing contact.

Operation contact

This is the primary contact for the site.

Operation contact first name (required) Operation contact last name (required) Job title (required)

Do not use special characters ($, &, #).

Phone number (required)

Format as xxx-xxx-xxxx.

Email (required) Confirm email (required)