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Generator Information
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Generator |
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| Site Address |
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| Mailing
Address (if different) |
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| U.S. EPA ID Number |
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| SIC Code: |
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| Technical Contact |
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| Title |
|
| Email |
|
| Phone Number |
(
)
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| Fax Number |
(
)
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| Name of Waste |
|
| Process of Generating
Waste |
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| Broker
Information |
|
Name |
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|
Address |
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City |
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State |
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| Zip |
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Contact |
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|
Email |
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|
Phone |
(
)
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|
Fax |
(
)
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Characteristics |
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Color |
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|
BTU/LB |
|
|
Odor |
Mild
Strong
None |
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Physical State@70 |
Liquid
Semi-Solid
Solid |
|
Layers |
Multilayered
Bi-layered
Single
Layered |
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Free Liquids |
No
Yes
if yes then %
|
|
Flash Point |
<70
70-100
101-139
140-200
>200
No
Flash
Exact
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Density |
Lbs/Gal
Lbs/Ft
API Gravity |
|
PH Range |
<2
2.1-4
4.1-10
10.1-12.4
>12.5 |
|
Metals |
None
TCLP
(MG/L)
Totals(ppm)
Arsenic
Barium
Cadmium
Chromium
Lead
Mercury
Selenium
Silver
Copper
Nickel
Zinc
Cyanides
|
|
Physical/Chemical Composition |
|
|
%
%
%
%
%
All material must equal to 100%
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Shipping Information |
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Proper shipping Name |
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Hazard Class |
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|
UN/NA # |
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State Code |
(required if shipping as Non RCRA) |
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EPA Code |
We do not accept any EPA codes. |
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Non RCRA Hazardous |
Yes
No |
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Volume |
Drums
Boxes/Sacks
Gallons
Yards |
| |
One
Time
Monthly
Annually |
| |
Bulk
Liquids
Bulk
Solids
Drums |
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Method of Shipment |
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Special Handling Information |
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Generator
of this waste certifies, that the information above is true and
accurate. The determination of this waste stream was derived by state
certified analysis and/or generator knowledge. If the physical or
chemical composition(s) of the waste stream changes, the generator
will notify HCI Environmental & Engineering Service. prior to shipment. The
generator is solely responsible for the disposal of any material that
may be delivered to HCI Environmental & Engineering Service. that is not
disclosed in the above profile. |
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Your Name* |
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|
Title |
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Email Address* |
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Referred by |
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Notes |
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|
Date |
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|
Contact Phone Number |
(
)
-
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