Conditionally Exempt Small Quantity Generators (CESQG) Certification Form

Conditionally Exempt Small Quantity Generators must fill out a Certification Form prior to transporting hazardous material. The form can be filled out electronically below or can be downloaded as a pdf at the bottom of our CESQG page. Questions about the Certification Form can be directed to the special waste coordinator at 563-381-1300.

Business Name *

Type of Business

Billing Address *

Address 1 *

Address 2

City *

State *

Zip

Site Address *

Same as Billing Address

Address 1 *

Address 2

City *

State *

Zip

Contact Info *

First Name *

Last Name *

Title

EPA Identification Number

Phone * (ex: 555-555-5555)

Fax

Email *

Email Confirm *

CESQG Certification Agreement

I certify that I am or my firm is a hazardous waste generator within the State of Iowa and because of the small volume of hazardous waste generated and/or stored, I qualify for Conditionally Exempt Small Quantity Generator (CESQG) status. I understand that to qualify for CESQG status, I must meet both of the following conditions (as defined by 40 CFR Section 261.5):

Generate less than 220 pounds per month (100 kg) of hazardous waste, and never store more than 2,200 pounds (1,000 kg) on the site at any time; and
Generate less than 2.2 pounds per month (1 kg) of acute hazardous waste, and never store more than this amount on site at any time.

I further understand that if, in the future, I exceed the quantity limitations described above, I will become subject to additional regulations as a hazardous waste generator and will no longer be eligible to participate in this type of collection program.

I understand that to qualify for CESQG status, I must meet both of the following conditions (as defined by 40 CFR Section 261.5):

	Generate less than 220 pounds per month (100 kg) of hazardous waste, and never store more than 2,200 pounds (1,000 kg) on the site at any time.
	Generate less than 2.2 pounds per month (1 kg) of acute hazardous waste, and never store more than this amount on site at any time.

Name *

First Name *

Last Name *

Date *

Open the calendar popup.

Signature *

By checking this box I certify I have read the above statements and understand the conditions and provisions that apply to the use of the CESQG Hazardous Material Program. I certify that I have the right to make these statements on behalf of my firm or business.

Submit your Form