Waste Profile Form

Disposal Site:

Profile Information:

US EPA ID#:

State ID#:

TCEQ ID#:

Generator Information:

Company Name:

Address:

City:

State:

Zip:

Contact:

Title:

Phone:

Fax:

Email:

Is the billing information same as above:

Waste Questionnaire (check one):

Non-hazardous Waste:

Used Oil (as defined by CRF 279.1):

Virgin Product (must include MSDS):

Off-Spec Product (must include MSDS):

Petroleum Contact Water (PCW)/ Leaking Underground Storage Tank (LUST) Water:

Conditional Exempt Small Quantity Generator (CESQG):

Waste Description:

Common Name of Waste:

Process Generating Waste:

Other Process Information:

Unused Product or Chemical:

Waste by-product from process:

Spill Clean Up:

Planned Site Remediation:

Physical State:

% Free Liquid:

% Settled Solids:

% Total Suspended Solids:

Layers:

PH:

Odor:

Describe Odor:

Flash Point:

Specific Gravity (Range):

Color:

Viscosity:

TX Classification:

Transportation Information:

Method of Shipment:

Shipment Frequency:

Anticipated Volume:

MSDS Attached:

Analytical Attached:

Generator Certification:

By Clicking on the submit button below, the generator (or representative) certifies that all information submitted on this profile and attached documents is correct to the best of my knowledge. In addition, I certify the following: 1) This waste does not contain regulated quantities of PCB's (polychlorinated Biphenyls). 2) This waste is not hazardous by reference to local and state law or by reference to US EPA rules 40 CFR Part 261 Subpart C (characteristic hazardous waste). 3) This profile sheet and its attachments contain true and accurate descriptions of the waste material. All relevant information regarding known or suspected hazards in the possession of the generator have been disclosed. 4) The generator will promptly notify LES of any material change in the composition of the waste which could result in the waste otherwise being characterized as hazardous pursuant to US EPA rules.

Name:

Title:

Best Contact Phone #: