NSSI Waste Profile Form

Download as a PDF

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

PHYSICAL CHARACTERISTICS OF WASTE

COLOR

ODOR:

NONE:

STRONG:

MILD:

DESCRIBE:

PHYSICAL STATE @ 70 DEG F:

% SOLID % SLUDGE:

% LIQUID % POWDER:

SPECIFIC GRAVITY

FREE LIQUIDS

Yes: No:
VOLUME: %

pH:

n/a

<=2 >7 - 10

2.1 - 4 10 - 12.4

>4 - 7 >4 - 7x

LAYERS

HOMOGENOUS:

BI:
MULTILAYERED:

FLASH POINT

CLOSED:

OPEN:

ACTUAL:

NONE:

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.