<p> Annual Report Form. Holder of a Permit for the Transportation of Residual Hazardous Materials to a Disposal Site</p><p>-Annual Management Report- Transport of Residual Hazardous Materials to a Disposal Site</p><p>Legal References: Environment Quality Act, R.S.Q., Chapter Q-2, section 70.9 Hazardous Materials Regulation, Chapter Q-2, r.32*, sections 130, 134, and 137</p><p>Firm Identification</p><p>Ministerial no.: CIDREQ1 no.: Firm name: </p><p>Permit no.: Permit expiry date: </p><p>Registered Firm Address Postal Address (if different) No.: No.: Street: Street: P.O. Box: Municipality: Municipality: Province or State: Province or State: Postal Code or Zip: Postal Code or Zip: </p><p>Name of Person in charge: Phone no.: Date: E-mail: </p><p>Calendar Year * Due to a change to regulation numbering that followed adoption of the Act respecting the Compilation of Québec Laws and Regulations, RSQ, c R-2.2.0.0.2, regulation # Q-2, r.32 henceforth replaces former regulation # Q-2, r.15.2.</p><p>1 This number correspond’s to the number attributed to your firm by Centre informatique du registre des entreprises du Québec (CIDREQ) and registered with the Inspector General of Financial Institutions (IGFI).</p><p>Ministère du Développement durable, de l’Environnement et de la Lutte contre les changements climatiques 1 Annual Report Form. Holder of a Permit for the Transportation of Residual Hazardous Materials to a Disposal Site</p><p>List of Residual Hazardous Materials Transported during the Year</p><p>Must be filled only if the To be filled in all cases To be filled in all cases RHM was generated in Québec RHM generated in Québec RHM generated in Québec and Canada and Canada Identification Code of Regulation designation from PIN from TDGR Hazardous Materials TDGR (Column III of list  of Schedule ) described in Section 2 of (Column I of list  of Schedule ) Schedule 4 of the HMR RHM generated outside RHM generated outside Canada Canada Regulation designation from PIN from REIDD REIDD (Column II of parts I, II, III or IV of (Column I of parts I, II, III or IV of Schedule 3) Schedule 3) Example: E09 4.3 S Aluminum by-product UN 3170</p><p>For each category of hazardous materials listed, please complete the tables on pages 3 and 4.</p><p>Ministère du Développement durable, de l’Environnement et de la Lutte contre les changements climatiques 2 Annual Report Form. Holder of a Permit for the Transportation of Residual Hazardous Materials to a Disposal Site</p><p>Identification Code of Hazardous Materials as provided in section 2 of Schedule 4, or the PIN assigned under the TDGR in accordance with RHM origin</p><p>Residual Hazardous Materials Received from Each Consignor</p><p>Quantity Consignors transported (Kg) Firm Name Address: No. and Street </p><p>City, Province (State) Postal Code (Zip) Firm Name Address: No. and Street </p><p>City, Province (State) Postal Code (Zip) Firm Name Address: No. and Street </p><p>City, Province (State) Postal Code (Zip) Firm Name Address: No. and Street </p><p>City, Province (State) Postal Code (Zip) Firm Name Address: No. and Street </p><p>City, Province (State) Postal Code (Zip) Firm Name Address: No. and Street </p><p>City, Province (State) Postal Code (Zip) </p><p>Ministère du Développement durable, de l’Environnement et de la Lutte contre les changements climatiques 3 Annual Report Form. Holder of a Permit for the Transportation of Residual Hazardous Materials to a Disposal Site</p><p>Identification Code of Hazardous Materials as provided in section 2 of Schedule 4, or the PIN assigned under the TDGR in accordance with RHM origin</p><p>Residual Hazardous Materials Delivered to a Disposal Site2</p><p>Quantity Consignees delivered (Kg) Firm Name Address: No. and Street </p><p>City, Province (State) Postal Code (Zip) Firm Name Address: No. and Street </p><p>City, Province (State) Postal Code (Zip) Firm Name Address: No. and Street </p><p>City, Province (State) Postal Code (Zip) </p><p>2 In Québec, there are only 2 consignees operating a disposal site: Laidlaw at Ville Mercier, and Stablex at Blainville.</p><p>Our firm did not transport any residual hazardous material to a disposal site this year.</p><p>I hereby certify that the information provided in this Annual Management Report is complete and true.</p><p>Signature Date</p><p>Please send back the form to the following address:</p><p>Ministère du Développement durable, de l’Environnement et de la Lutte contre les changements climatiques Direction des matières dangereuses et des pesticides 675, boul. René-Lévesque Est 9e étage, Boîte 71 Québec (Québec) G1R 5V7</p><p>Ministère du Développement durable, de l’Environnement et de la Lutte contre les changements climatiques 4</p>