Waste Profile

Generator
Comments
EPA ID #*
Generators Name*
Missouri ID #*
Profile*
Product*
Is the Generator a TSDF?*
- Yes
- No
Street*
PO Box
City*
State*
Zip*
Tech Contact Name*
Title*
Phone Number*

Billing
Billing Name*
Street*
PO Box
City*
State*
Zip*
Tech Contact Name*
Title*
Phone Number*

General Waste Information
Material Description*
Process Description*
Shipping Container*
- Check all that apply
- Select All
- Bulk
- Drums
- Boxes / Bags
Shipping Method*
- Check all that apply
- Select All
- Truck
- Railcar
Shipping Volume and Frequency*
Give Details

Attach MSDS for components requiring employee communication under OSHA
Also, if available, attach current analysis representative of the material.
MSDS
Max. file size: 125 MB.
Analysis
Max. file size: 125 MB.

Chemical Composition/Waste Constituents
List components, attach additional sheets if needed
List*
List components Concentration Range (lower) Concentration Range (upper) Typical %

Specific Analysis of Waste
Must be completed if an analysis is not attached or a sample is not submitted
Arsenic
Selenium
Silver
Nickel
Lead
Thallium
Cadmium
Barium
Beryllium
Chromium
Antimony
Mercury
Fluorine
Chlorine
Bromine
Phosphorus
Sulfur
Iodine
Aluminum
Silicon
Heat of Combustion
Specific Gravity
pH (range)
Water
Ash
Flash point

Substances which may be in the material:
Check all of the following substances which may be in the material:*
- Nitrocellulose (Usually found in LACQUER DUST Streams)
- DOT Corrosives, Poisons, Forbiddens, Radioactives, Explosives, or Gases
- TSCA regulated materials (PCBs, PBBs, Chlorinated dibenzodioxins or furans)
- Materials used exclusively as pesticides, herbicides, insecticides, etc.
- Toxic components with ACGIH TLV less than 2 ppm or 8 mg/m³
- CERCLA Regulated (Superfund) Waste
- Water reactive components (Isocyanates, Acid Chlorides, Anhydrides, etc.)
- Biological hazards (Pathogenics, Infectious agents, Etiologic agents, etc.)
- None of the above

DOT Information
Proper shipping name*
Hazard Class*
UN/NA Number*
P.G*
Special Handling Information*
DOT Hazardous Material*
- Yes
- No
Email*
Required Certifications*
Regarding the waste material submitted for acceptance to GAR, I certify all of the following:
1) That any PCB materials present at < 50 ppm in the waste shipment DID NOT result from any dilution of materials containing > 49 ppm PCBs. Furthermore, I certify that the waste shipment meets NONE of the definitions of descriptions of PCBs, PCB items, or PCB contaminated materials found in 40 CFR 761.1, 761.3, and 761.70.

2) In addition, if any of the waste codes listed in Appendix XI of 40 CFR 268 - Metal Bearing Wastes Prohibited from Dilution in a Combustion Unit According to 40 CFR 268.3 (C) - are present, at least one of the following criteria have been met.
a) The waste contains hazardous organic constituents or cyanide at levels exceeding the constituents - specific treatment standard found in 40 CFR 268.48. This is the table of Universal Treatment standards covering 126 organic approximately compounds. The vast majority of the limiting concentrations for waste waters are less than 1 mg/l.
b) The waste consists of organic debris-like materials, such as, wood, paper, plastics, or cloth, contaminated with inorganic metal-bearing hazardous waste.
c) The waste, at point of generation, has reasonable heating value such as greater than or equal to 5000 Btu per pound;
d) The waste is co-generated with wastes for which combustion is a required method of treatment. For a list of such wastes, see 40 CFR 268.40.
e) The waste is subject to federal and/or state requirements necessitating reduction of organics.
f) The waste contains greater than 1% Total Organic Carbon (TOC).

3) The waste does not contain Hg at concentrations equal to or greater than 260mg/kg or is otherwise subject to the land ban restriction on the combustion of Hg containing wastes found in 40CFR 268.40.

I further certify that all information submitted in this and all attached documents contains true and accurate descriptions of the waste. Any sample submitted is representative as defined in 40 CFR 261 - Appendix 1 or by using an equivalent method. All relevant information regarding known or suspected hazards in the possession of the generator has been disclosed to GAR.
Signature*

Step 1 of 11 - Generator

Generator

Billing

General Waste Information

Attach MSDS for components requiring employee communication under OSHA

Chemical Composition/Waste Constituents

Reactive Characteristics

EPA Information

Specific Analysis of Waste

Specific Gravity

Physical Properties

Substances which may be in the material:

DOT Information

List components	Concentration Range (lower)	Concentration Range (upper)	Typical %