AFRICA Q-HSE DEPARTMENT
WASTES TRACKING FORM
Document N°: HSE-F-0560 Rev 04
SECTION A
Description (Bolloré Logistics)
Waste description:
Waste 1
Type Nature Origin/description Quantity
□ Dangerous □ Solid
□ Not Dangerous □ liquid
□ Other
Waste 2
Type Nature Origin/description Quantity
□ Dangerous □ Solid
□ Not Dangerous □ liquid
□ Other
Date of collection: ______________________________ Time of collection: ______________________
Note: This waste is only to be delivered to a waste specialized company, in compliance with legal requirements. It must NOT be
disposed off elsewhere
Site Manager / Q-HSE Officer: Signature:
SECTION B SECTION C
Exit authorization (Bolloré Logistics) Waste final treatment company
This to confirm that the above described wastes were
Vehicule N°: Driver received at our waste storage/treatment site
Vehicule N°: Driver
Vehicule N°: Driver Authorization was given to unload
Authorization was denied to unload because:
Vehicule N°: Driver The wastes did not comply with the
description given in Section A
The container contained wastes, which
had not been correctly segregated
The above described waste are authorised to be removed
from Other reason (provide details)
Date: Authorized person signature Signed for Company (name and signature)
Date:_______________ Time: _______________
NB: This document must be completed for each type of wastes and must follow the waste until final treatment. Once the treatment
performed, a copy must be sent back to producer