(DSWM) Asbestos Disposal Form

Miami-Dade County Department of Solid Waste Management
Special Waste Disposal Request
Waste Hauler

Company Name:

Address:

Contact Name:Phone:

Email:
Email address (Waste Hauler):
Example: john.doe@miamidade.gov
Main Point of Contact?
Generator

Company Name:

Address:

Contact Name:Phone:

Email:
Street Address (Generator)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email address (Generator):
Example: john.doe@miamidade.gov
Main Point of Contact?
ENVIORNMENTAL CONSULTANT

Name:

Address:

Contact Name:Phone:

Email:
Email address (Environmental Consultant):
Example: john.doe@miamidade.gov
Main Point of Contact?
SHIPPING
Estimated Quantity:

Estimated Quantity:

Street Address Line 2

CityState / Province

Postal / Zip Code
Units of measure:

Other
Estimated number of trucks:

Number of trucks:

Street Address Line 2

CityState / Province

Postal / Zip Code
Estimated job duration:
Number (in months)
Estimated start date and hauling:

MonthDayYear
***The date selected for "Estimated start date and hauling" will be denied if not selected with a 24 hour notice.***
Container Type and Size:

Miami-Dade County Department of Solid Waste Management
Waste is double‑bagged in ≥6‑mil polyethylene bags or placed in a sealed, leak‑tight container (drum/box), preventing fiber release.
Bags/containers intact (no tears, punctures, or leaks).
Exterior surfaces clean—no visible asbestos debris on bag/container exteriors or truck bed.
Labels present on each bag/container: asbestos hazard warning (e.g., “Contains Asbestos – Avoid Creating Dust – Cancer and Lung Disease Hazard”).

Miami-Dade County Department of Solid Waste Management
Contains Asbestos?
If Yes:
Please attach DERM approval letter:

Cancelof
Other information attached? (such as MSDS?)
GENERATOR CERTIFICATION

By signing this form, I hereby certify that all information submitted in this and all attached documents are true for proper material characterization, and to identify known and suspected hazards.
Signature:
Please check below to acknowledge:
Generator Certification

Name (Print)

Date:

Title:State / Province

Company:
Should be Empty:

Miami-Dade County Department of Solid Waste Management