
1. Work site name and mailing address Asbestos Waste Shipment Record (See Completion Instructions on Reverse) Owner’s name 2. Operator’s name and address Owner’s telephone no. Operator’s telephone no. Authorized agent: 3. Waste disposal site (WDS) name, mailing address, physical site location: WDS phone no. GENERATOR Permit No. 4. Name and address of responsible agency: Tennessee Department of Environment & Conservation Division of Air Pollution Control William R. Snodgrass Te.
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How to fill out the TN CN-1054 online
The TN CN-1054 form is essential for documenting the transportation and disposal of asbestos waste in Tennessee. This guide provides clear, step-by-step instructions to help users efficiently complete the form online.
Follow the steps to accurately complete the form online.
- Click 'Get Form' button to obtain the TN CN-1054 and open it in the editor.
- In section 1, enter the work site name and mailing address. Include the owner's name and phone number.
- For section 2, provide the operator's name and address, along with their phone number and the authorized agent's information.
- In section 3, fill in the waste disposal site (WDS) name, mailing address, physical site location, and phone number. If applicable, include the WDS permit number.
- In section 4, enter the name and address of the responsible agency, which is the Tennessee Department of Environment and Conservation.
- Section 5 requires a description of the asbestos waste generated, including the types (e.g., friable, non-friable).
- In section 6, indicate the number of containers used and their type based on the provided codes.
- For section 7, specify the total quantity of asbestos material in either cubic yards or gallons.
- Use section 8 to include any special handling instructions or additional information necessary for transport.
- Section 9 requires the authorized agent to read, sign, and date the certification statement.
- For sections 10 and 11, provide the necessary details of the transporter(s), including names, signatures, and dates of receipt.
- In section 12, note any discrepancies between the waste information reported and what has actually been received.
- Complete section 13 with the waste disposal site owner's information, confirming receipt of materials.
- Once all fields are completed, you can save changes, download, print, or share the form as needed.
Complete the TN CN-1054 online to ensure proper handling of asbestos waste.
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