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NSSI/RECOVERY SERVICES, INC. WASTE PROFILE FORM

P.O. BOX 34042 HOUSTON, TEXAS 77234    TEL 713-641-0391    FAX 713-641-6153    TXD982560294    TX REG. 38669


COMPANY INFORMATION
GENERATOR NAME:
FACILITY ADDRESS:
TECHNICAL CONTACT:
PHONE: FAX:
EPA ID NO: STATE ID:
BILLING NAME:
BILLING ADDRESS:
BILLING CONTACT:
PHONE: FAX:
PROFILE#:
WASTE STREAM NAME:
PROCESS GENERATING WASTE:

PHYSICAL CHARACTERISTICS OF WASTE
COLOR
ODOR:
DESCRIBE:
STRONG:
MILD:
PHYSICAL STATE @ 70 DEG F:
% SOLID % SLUDGE:
% LIQUID % POWDER:
SPECIFIC GRAVITY
FREE LIQUIDS
Yes: BI:
MULTILAYERED:
PH:
n/a
<=2 >7 - 10
2.1 - 4 10 - 12.4
>4 - 7 >4 - 7x
LAYERS
HOMOGENOUS:
No:
VOLUME:
SPECIFIC GRAVITY

CHEMICAL COMPOSITION (TOTAL MUST ADD TO 100%) ATTACH ANALYTICAL AND SPECIAL INFORMATION

CONSTITUENT MIN% MAX% CONSTITUENT MIN% MAX%

METALS TOTAL(PPM)________TCLP (MG/L)_______ANALYTICAL (ATTACHED)________GENERATOR KNOWLEDGE

ARSENIC BARIUM CADMIUM CHROMIUM
CHROMIUM-HEX LEAD MERCURY SELENIUM
SILVER COPPER NICKEL ZINC
THALLIUM OTHER(SPECIFY)

OTHER TOTAL(PPM)________TCLP (MG/L)_______ANALYTICAL (ATTACHED)________GENERATOR KNOWLEDGE

CYANDIES SULFIDES PCBS PHENOLICS
CHLORIDES FLUORIDES PHOSPHATES NA+/K+

HAZARDOUS CHARACTERISTICS USEPA HAZARDOUS WASTE:___________STATE HAZARDOUS WASTE:___________

REACTIVITY NONE PYROPHORIC SHOCK SENSITIVE EXPLOSIVE WATER OTHER
OTHER HAZARDS NONE RADIOACTIVE ETILOGICAL OTHER

EPA WASTE CODES:_____________________________________ STATE WASTE CODES:_____________________________________________

SHIPPING INFORMATION DOT HAZARDOUS MATERIAL? HAZARD CLASS: UN/NA NO:
SHIPPING DESC.:
SHIPPING METHOD DRUM (TYPE/SIZE) Pricing Code: Routing Code
ANTICIPATED VOLUME (QUANTITY): Alt Routing Codes: Storage Code
FREQUENCY ONE TIME WEEKLY MONTHLY QUARTERLY ANNUALLY

I HEREBY CERTIFY THAT ALL INFORMATION SUBMITTED IN THIS AND ALL ATTACHED DOCUMENTS IS COMPLETE AND ACCURATE, WITH DISCLOSURE OF ALL KNOWN OR SUSPECTED HAZARDS.

AUTHORIZED SIGNATURE
DATE

CFR 40 264.12(b) NSSI has the appropriate permit(s) to accept and receive the above profile material.

NSSI SIGNATURE
DATE