Waste Profile Form - Metro Waste Authority

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All fields marked with * are required.

Generator Information

Generator Name *

Address *

City/State/Zip Code *

County *

Site Location (If Different From Address)

Contact Name *

Phone Number *

Fax Number

Email *

Customer/Billing Information

Billing Name *

Address *

City/State/Zip Code *

County *

Contact Name *

Phone Number *

Fax Number

Payment by Cash, Check, or Credit Card? *

Note: If no account is set up, payment by cash, check, or credit card is required.

PO Number (If Required by Bill-To Customer)

If a PO number is required to be on the invoices, the number must be provided before waste can be brought in.

Transporter Information

Transporter Name *

Address *

City/State/Zip Code *

Phone Number *

Fax Number

Contact Name *

Agent/Consultant Information

Agent/Consultant Name *

Address *

City/State/Zip Code *

Phone Number *

Fax Number

Contact Name *

Waste Stream Information

Common Name of Waste *

Detailed Description of Process *

Physical State at 70° F *

If Other, Describe

Odor *

If Significant, Describe

Color *

Flash Point (in ° F and ° C) *

Reactive? *

If Yes, With What

pH Range *

Heat Generating Waste? *

Free Liquid? *

Water Content (% by Water) *

Does the Waste Contain USDOT Hazardous Material, PCB's, or Asbestos? *

Does the Waste Contain any Etiological Agents or Untreated Medical Waste? *

Is the Proposed Waste a Hazardous Waste Defined by Federal or State Regulations? *

Supplemental Information

Attached Document(s) Include

MSDS
Certified Analytical Report
Memo/Letter
Process Knowledge

If Analytical Data is Attached, is the Data Derived From Testing a Representative Sample in Accordance with 40 CFR 261 and/or Other Applicable Laws?

Shipping Information

Packaging *

If Other, Describe

Estimated Volume *

If Other, Describe

Shipping Frequency *

If Other, Describe

Disposal Method *

If Other, Describe

Generator's Certification Statement

I hereby certify that the material named is not a hazardous waste as defined by 40 CFR 261 or any applicable state law, that all known or suspected hazards have been disclosed, that there are no other economical or environmentally safe ways to manage this material and that all information submitted is complete and accurate. If any of the above information changes, I agree to notify Metro Waste Authority prior to offering the waste for shipment or management. *

Name *

Company Name *

Date *