GENERATOR'S WASTE PROFILE FORMSuperior environmental service means a lot to us, fill out your waste profile form to help us serve you better. General Information Waste Information Shipping Information Generator's Certification Generator Information Site Information Waste Information Analytical data attached (file limit: 1.5MB): YesNo MSDS attached (file limit: 1.5MB): YesNo Waste Characteristics IndustrialCommercialMunicipalFood ProcessingGray WaterGround WaterRain WaterHolding TankGrease (Food Svc.)Septage (Domestic)Oily Waste WaterResidualSlurrySpent Filter MediaSludgeOther Physical State %solids0%10%20%30%40%50%60%70%80%90%100% Oil SheenLiquidSludgeSolid Quantity of Waste: Shipping Information VacuumVacuum TankerVacuum ContainerDewatering BoxRoll Off ContainerJet Vac Size of bulk: 5,0006,0007,000Other Shipping Frequency Per: MonthQuarterYearDayOne TimeOther Was this waste stream previously transported for disposal at an approved facility? YesNoIf yes, please provide the facility's name and the proper shipping name under which the waste was classified Generator Certification 1. Is this waste RCRA nonhazardous? YesNoIf no, please attach details & description below 2. Is the waste generated as CERCLA/Superfund Site? YesNo 3. Is the waste represented by this waste profile a categorial waste as defined in 40 CFR 439? YesNo 4. Does the waste represented by this waste profile contain concentrations of Polychlorinated Biphenyls (PCBS) regulated by 40 CFR 761? YesNo 5. Does the waste represented by this waste profile contain true and accurate descriptions of the waste material, and has all relevant information within the possession of the Generator regarding known or suspected hazards pertaining to the waste been disclosed to the contractor? YesNo 6. Will all changes occur in the composition of the waste be identified by the Generator and disclosed to the contractor prior to making the waste available for pumping, transportation and disposal? YesNo Any sample submitted is representative as defined in 40 CFR 261 - Appendix 1 or by using equivalent method. I authorize Russell Reid to obtain a sample from any waste shipment for purposes of recertification. If approved by management, Contractor has all neccessary permits and licenses for the waste that has been categorized and identified by this approval profile. By entering the below fields, I understand I am electronically signing this form. Additional information attached (file limit: 1.5MB): YesNo PreviousNext Form does not autosave, any changes will be lost on page refresh
