Lamp Ballast Electronic Inventory Form.pdf
PDF 191 KB Posted
- Attached to
- Hazardous Waste Services - Statewide
- Contract number
- 505ENT-M20-HZRDSWSTSV-01
- Issued by
- Wisconsin
About this file
This is a State of Wisconsin Lamp, Ballast, and Electronics Inventory Form used for documenting and tracking hazardous waste materials collected from state facilities. The document serves as a collection and inventory tracking system for the Wisconsin state government to manage the disposal of various electronic waste and lighting equipment containing hazardous materials.
The form covers a comprehensive range of items including fluorescent lamps of various sizes, high intensity discharge lamps, incandescent bulbs, LED lighting, PCB and non-PCB ballasts, capacitors, and multiple battery types (lead acid, nickel cadmium, lithium ion, lithium metal, and alkaline). It also includes expired televisions, monitors, and other electronic equipment priced per pound. The form requires documentation of DOT-approved UN container packaging for certain hazardous materials and tracks the number of shipping containers, container types, bulb quantities, and container weights. Additionally, it includes a supplies section listing various storage containers and drums (ranging from 5-gallon to 55-gallon capacity) with UN ratings for proper hazardous waste containment and transportation compliance.
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Text version
Generating Address/Pick-up Address Facility Name:
Address:
City: State: Zip:
Contact Name: Phone Number e-mail address:
Bill To Address (if Different) Facility Name:
Address:
City: State: Zip:
Contact Name Phone Number
# of
Shipping
Containers
Type of
Containers # of bulbs
Weight of
Container
Broken Lamps - Per lb.
4' & Under Florescent Lamps 5' & Over Fluorescent Lamps Fluorescent Compacts/U-Shapes/Circular High Intensity Discharge (HID - All types) Standard Incandescent Flood or Spotlight Incandescent UV Lamps 4' and Under Fluorescent Lamps (Shatterproof) Neon Lamps
LED
Lighting Fixture (PCB) PCB Ballasts Capacitors (PCB) Non-PCB Ballasts Lead Acid Batteries Nickel Cadmium Batteries (includes NiMH) Lithium Ion Batteries (Rechargeable) Lithium Metal Batteries (Non-Rechargeable) Alkaline Batteries Expired TV's / Monitors - Per lb.
Expired Electronic Equipment - Per lb.
Supplies Needed Quantity Comments:
4' Lamp Barrel Stand 4' Lamp Storage Barrel 8' Lamp Storage Barrel 4' Lamp Storage Box 8' Lamp Storage Box 5 Galllon Poly Drum (UN Rated) 30 Gallon Metal Drum (UN Rated) 55 Gallon Poly Drum (UN Rated) Cubic Yard Box (UN Rated) 10 Gallon Fiber Box (UN Rated) 20 Gallon Fiber Box (UN Rated) 30 Gallon Fiber Box (UN Rated)
YES / NO
Not Applicable
Not Applicable Not Applicable Not Applicable
State of WI
Lamp, Ballast, and Electronics Inventory Form
YES / NO
YES / NO
YES / NO
YES / NO
YES / NO
YES / NO
Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable
YES / NO
Packaged in DOT approved UN
Container?
Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable
File details come from the government source that posted it. Updated .