GOVERNMENT OF THE U.S. VIRGIN ISLANDS 
          DEPARTMENT OF PLANNING & NATURAL RESOURCES 
          DIVISION OF ENVIRONMENTAL PROTECTION 
 
 
 
 
(340) 773-1082 / 774-3320 
 
 
 
 
 
 
 
 
 
 
Application for Infectious Medical Waste Transporter Registration 
 
 
 
    
Infectious medical waste transporters must be permitted by DPNR.  The initial permit is $55.00 (vehicle).  Each additional vehicle is $10.00.   
Permits expire on March 31st of each year.  The permit fee for the renewal applications received by April 1st is $55.00 (one vehicle).  Each additional 
vehicle is $10.00.  The permit fee for renewal applications received after April 1st is $75.00.  Each additional vehicle is $10.00.  Please submit the 
completed form to DPNR-DEP. 
 
1. 
Application for (choose one):  ______ New     
 
_______Renewal  
(Applicant must be a legal entity, i.e.: Individual, partnership, corporation, association, or public body) 
 
2. 
Facility Name: ___________________________________________________________________________________________________ 
 
3. 
Facility Address:__________________________________________________________________________________________________ 
Street 
 
 
 
City 
 
State 
 
Zip Code 
4. 
Contact Person:  _______________________________________________Telephone____(____)_________________________________ 
 
5. 
Name of Facility Owner:  __________________________________________________________________________________________ 
 
6. 
Mailing Address of Facility Owner:___________________________________________________________________________________ 
 
7. 
Business Phone:  ___(____)_________________________  
 
8. 
24 Hour Emergency Phone:  __(___)__________________________________ 
 
9. 
Name of Property Owner:  __________________________________________________________________________________________ 
 
10. Mailing Address of Property Owner:__________________________________________________________________________________ 
  Street 
 
 
 
 
City 
 
State 
         Zip Code 
 
11. FEDERAL employer Identification Number of transporter: ________________________________________________________________ 
 
12. Anticipated districts to be served: 
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________ 
 
13. List all known facilities where you will be taking infectious medical waste or further storage (attach additional sheets if necessary): 
 
STORAGE 
TREATMENT 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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DPNR use only: Payment Type   ____ Check ____Cash 
 
 
 
 
 
 
Date Received__________________ 
Receipt No.__________ 
 
Permit No._____________________ 
Date Issued__________ 
14. Number of transport vehicles to be used:______________ 
 
15. Please submit the following information for each transport vehicle you wish to register (attach additional sheets, if necessary): 
 
YEAR 
MAKE 
MODEL 
TAG NUMBER 
VEHICLE IDENTIFICATION NUMBER 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
16. For renewals only: Please attach copy of Manifest for Infectious Medical Waste transported in the last year. 
 
 
17. CERTIFICATION: 
 
I certify that, to the best of my knowledge and belief, the information provided in this application is true and accurate. 
 
 
___________________________________________ 
_______________________________________________     
 ____________ 
Signature of Authorized Representative  
       Name of Authorized Representative (print or Type)           
        Date 
 
 
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