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FOR BHF USELL1 2021STATE OF ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES FINANCIAL AND STATISTICAL REPORT (COST REPORT) FOR LONGER CARE FACILITIES (FISCAL YEAR 2021) I.DPH License ID Number: Facility

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Any individual or organization that is disposing of hazardous waste is required to fill out the oformr specify hazardous disposals form.

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Oformr specify hazardous disposals is a form used to report specific hazardous waste disposals.

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Information such as the type of hazardous waste, quantity disposed, disposal method, and disposal location must be reported on oformr specify hazardous disposals.

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