[별지 제2호서식] <개정 2009.12.31>						(앞쪽)
Movement Document for Transboundary Movements of Waste (수출이동서류)
1. Corresponding to Notification N° :				2. Serial/total number of shipments : /
3. Exporter Registration N° : Name : Address : Contact person : Tel : Fax : Email :		4. Importer Registration N° : Name : Address : Contact person : Tel : Fax : Email :
5. Actual quantity : kg : ㎥ :		6. Actual date of shipment :
7. Packaging Type(s)(1) : Number of packages : Special handling requirements(2) : Yes : □ No : □
8.(a) 1st Carrier(3) : Registration N° : Name : Address : Tel : Fax : Email :	8.(b) 2st Carrier : Registration N° : Name : Address : Tel : Fax : Email :				8.(c) 3rd Carrier : Registration N° : Name : Address : Tel : Fax : Email :
To be completed by carrier's representative More than 3 carriers(2) □
Means of transport(1) : Date of transfer : Signature :	Means of transport(1) : Date of transfer : Signature :				Means of transport(1) : Date of transfer : Signature :
9. Waste generator(s)(4;5;6) : Registration N° : Name : Address : Contact person : Tel : Fax : Email : Site of generation(2) :		12. Designation and composition of the waste(2) :
		13. Physical characteristics(1) :
		14. Waste identification(fill in relevant codes) (ⅰ) Basel AnnexⅧ(or Ⅸ if applicable) : (ⅱ) OECD code(if different from (ⅰ)) : (ⅲ) EC list of wastes : (ⅳ) National code in country of export : (ⅴ) National code in country of import : (ⅵ) Other(specify) : (ⅶ) Y-code : (ⅷ) H-code(5) : (ⅸ) UN class(5) : (ⅹ) UN Number : (ⅺ) UN Shipping name : (ⅻ) Customs code(s) (HSK) :
10. Disposal facility □ or Recovery facility □ Registration N° : Name : Address : Contact person : Tel : Fax : Email : Actual site of disposal/recovery(2)
11. disposal/recovery operation(s) D code / R code(1) :
15. Exporter's / Generator's(1) declaration : I certify that the above information is complete and correct to my best knowledge. I also certify that legally-enforceable written contractual obligations have been entered into, that any applicable insurance or other financial guarantee is in force covering the transboundary movement and that all necessary consents have been received from the competent authorities of the countries concerned. Name : Signature : Date :
16. For use by any person involved in the transboundary movement in case additional information is required
TO BE COMPLETED BY DISPOSAL/RECOVERY FACILITY
17. Shipment received at disposal facility □ or recovery facility □ Date of reception : Accepted : □ Rejected* : □ Quantify received : kg : ㎥ : *immediately contact Approximate date of disposal/recovery : competent authorities Disposal/Recovery operation(1) : Date : Name : Signature :						18. I certify that the disposal/recovery of the waste described above has been completed. Date : Name : Signature and stamp :
(1) See list of abbreviations and codes on the next page (2) Attach details if necessary (3) If more than 3 carriers, attach information as required in blocks 8(a,b,c).							(4) Required by the Basel Convention (5) Attach list if more than one (6) If required by national legislation
			210mm×297mm(일반용지 60g/㎡)

(뒤쪽)
FOR USE BY CUSTOMS OFFICES(if required by national legislation)
19. COUNTRY OF EXPORT OR CUSTOMS OFFICE OF EXIT The waste described in this movement document has left the Country on : Signature : Stamp :						20. COUNTRY OF IMPORT OR CUSTOMS OFFICE OF ENTRY The waste described in this movement document has entered Country on : Signature : Stamp :
21. STAMPS OF CUSTOMS OFFICES OF TRANSIT COUNTRIES
Name of country :						Name of country :
Entry :			Departure :			Entry :				Departure :
Name of country :						Name of country :
Entry :			Departure :			Entry :				Departure :
List of Abbreviation and Codes Used in the Movement Document
DISPOSAL OPERATIONS(Block 11)								RECOVERY OPERATIONS(Block 11)
D1 D2 D3 D4 D5 D6 D7 D8 D9 D10 D11 D12 D13 D14 D15	Deposit into or onto land(e.g., landfill, etc.) Land treatment(e.g., biodegradation of liquid or sludgy discards in soils, etc.) Deep injection.(e.g., injection of pumpable discards into wells, salt domes or naturally occurring repositories, etc.) Surface impoundment(e.g., placement of liquid or sludge discards into pits, ponds or lagoons, etc.) Specially engineered landfill(e.g., placement into lined discrete cells which are capped and isolated from one another and the environment) Release into a water body except seas/oceans Release into seas/oceans including sea-bed insertion Biological treatment not specified elsewhere in this list which results in final compounds or mixtures which are discarded by means of any of the operations in this list Physico-chemical treatment not specified in this list which results in final compounds or mixtures which are discarded by means of any of the operations in this list(e.g., evaporation, drying, calcination) Incineration on land Incineration at sea Permanent storage(e.g., emplacement of containers in a mine, etc.) Blending or mixing prior to submission to any of the operations in this list Repackaging prior to submission to any of operations in this list Storage pending any of the operations numbered in this list							R1 R2 R3 R4 R5 R6 R7 R8 R9 R10 R11 R12 R13	Use as a fuel(other than in direct incineration) or other means to generate energy Solvent reclamation/regeneration Recycling/reclamation of organic substances which are not used as solvents Recycling/reclamation of metals and metal compounds Recycling/reclamation of other inorganic materials Regeneration of acids or bases Recovery of components used for pollution abatement Recovery of components from catalysts Used oil re-refining or other reuses of previously used oil Land treatment resulting in benefit to agriculture or ecological improvement Uses of residual materials obtained from any of operations numbered R1-R10 Exchange of wastes for submission to any of the operations numbered R1-R11 Accumulation of material intended for any operation in this list
PACKING TYPES(Block 7) 1. Drum 2. Wooden barrel 3. Jerrican 4. Box 5. Bag 6. Composite Packaging 7. Pressure receptacle 8. Bulk 9. Other(specify)				H CODE AND UN CLASS(Block 14)
					UN Class	H code	Characteristics
					1 3 4.1 4.2 4.3 5.1 5.2 6.1 6.2 8 9 9 9 9	H1 H3 H4.1 H4.2 H4.3 H5.1 H5.2 H6.1 H6.2 H8 H10 H11 H12 H13	Explosive Flammable liquids Flammable solids Substances or Wastes liable to spontaneous combustion Substances or wastes which, in contact with water, emit flammable gases Oxidizing Organic peroxides Poisonous(acute) Infectious substances Corrosives Liberation of toxic gases in contact with air or water Toxic(delayed or chronic) Ecotoxic Capable, by any means, after disposal of yielding another material, e.g., leachate, which possesses any of the characteristics listed above
MEANS OF TRANSPORT(Block 8) R=Road T=Train/Rail S=Sea A=Air W=Inland Waterways
PHYSICAL CHARACTERISTICS(Block 13)
1. Powdery/Powder 2. Solid 3. Viscous/paste 4. Sludgy		5. Liquid 6. Gaseous 7. Other(specify)
※ 주의 해당 수입폐기물의 수출이동서류를 작성(변경작성 포함)하지 아니하거나 허위로 작성한 자 또는 수출이동서류에 기재된 내용을 준수하지 아니한 자는 「폐기물의 국가간 이동 및 그 처리에 관한 법률」 제29조에 따라 3년 이하의 징역 또는 1천만원 이하의 벌금에 처합니다. 또한, 해당 수출이동서류를 지니지 아니하고 폐기물을 운반하는 자 또는 동 서류에 해당 사항을 기재 또는 서명하지 아니한 자에게는 같은 법 제32조에 따라 100만원 이하의 과태료가 부과됩니다.