Generators Waste Material Profile Sheet
Section A - General Information
Generator Name: ____________________________________________________ Facility Address: ____________________________________________________ Mailing Address: ____________________________________________________ Technical Contact: ____________________________________________________ Name of Waste: ____________________________________________________ Process Generating Waste: ______________________________________________ Nature of Business: ____________________________________________________ EPA Form Code: ___________________________ SIC Code: _______
Billing Information:
Name: _____________________________________________________________ Address: ___________________________________________________________ City: State: Zip Code: ________________________________________________ Phone Number: ______________________________________________________ E-Mail Address: ______________________________________________________
Section B - Generator Characteristics
Spill Cleanup: Yes No Cercia Waste: Yes No This Is A: WW NWW Debris Soil Virgin Product or Chemical: Yes No (If Yes, please mail MSDS) Generated From A Planting Operation: Yes No Anticipated Volume: Gallons Drums Tons Other Per: One Time Week Month Quarter Year Other Drum Type DOT Number Drum Size
IS THIS A HAZARDOUS WASTE AS DEFINED IN 40CFR261: Yes No If No, sign your name: ___________________________________________
Section C - DOT and RCRA Characteristics
DOT Proper Shipping Name:____________________________________________ Hazard Class: Packing Group____________________________________________ UN or NA: RQ: _____________________________________________________ US EPA Waste Codes: ________________________________________________ Note: If D001 (Except High TOC>10%), D002, or D002-D043 requires treatment of the characteristic, then the underlying hazardous constituent(s) present in the waste at the point of generation must be identified below:
Section D - Physical Characteristics
Chemical Composition (Totals MUST add up to 100%)
Physical State: Liquid Semi-Solid Solid Viscosity: Low Medium High Layering: Multi Bi-Layered Single Odor: None Mild Strong Color: ____________________________________________________ Free Liquids: Yes No Percent: ___________ Specific Gravity: ___________ Btu/Lb: ___________ Flash Point: ___________ Chlorides (%): ___________ PH: ___________ Water: ___________ Hazardous Characteristics as defined in 40CFR 261: Reactivity: None Phrophoric Shock Sensitive Explosive Water Reactive Other: ___________ Corrosivity: Yes No Ignitability: Yes No Toxicity: Yes No Listed: Yes No Other Hazardous Characteristics: None Radioactive Ethological Pesticide/Herbicides Waste Other ___________
Section E - TCLP (Indicate if the waste contains any of the following: Totals or TCLP
Section F
The above information is true and accurate and is based on an analysis of a representative sample of this waste in accordance with EPA guidelines, documents SW-846--1980 and EPA-600/2-80-018, or on my thorough knowledge of the waste.
By: ________________________________________________________
Title: _______________________________________________________
Date: _______________________________________________________
I authorize Environmental Alternatives to act as my agent to make corrections to this profile. Such corrections being consistent with the results of sample characteristics and/or regulatory requirements of the Alabama Department of Environmental Management or USEPA. I understand that a corrected copy will be sent to me by Environmental Alternatives.
Yes No Initials: ___________
