SECTION 1: GENERAL INFORMATION
COMPANY NAME Enter the name of the facility where the waste is generated.
EPA ID # What is the facility's 3-letter, 9-number USEPA ID number?
ADDRESS Enter the street address (not P.O. Box) of the facility where the waste is generated.
CITY Enter the city where the waste is generated.
STATE Enter the state where the waste is generated.
ZIP Enter the zip or postal code where the waste is generated.
PHONE Enter the generator's area code and phone number.
FAX # Enter the generator's area code and fax number.
CONTACT PERSON Enter the name of the contact person for the generator.
BILLING ADDRESS Enter the street address (not P.O. Box) of the facility if different than above.
BILLING CITY Enter the city if different than above.
BILLING STATE Enter the state if different than above.
BILLING ZIP Enter the zip or postal code if differnet than above.
BILLING PHONE Enter the billing area code and phone number if different than above.
BILLING FAX # Enter the billing area code and fax number if different than above.
BILLING CONTACT PERSON Enter the name of the contact person for billing if different than above.
SECTION 2: WASTE DESCRIPTION
COMMON NAME Enter a name generally descriptive of this waste (e.g., paint sludge, fluorescent bulbs, etc.)
WASTE CODE  
PROCESS GENERATING WASTE Describe the process generating the waste in detail. List the specific process/operation or source that generates the waste (e.g., incineration of municipal refuse, asbestos removal, wastewater treatment, building maintenance, etc.)

SHIP VOLUME

  
FREQUENCY  
BULK  
DRUMS  
COLOR Describe the color of the waste (e.g., blue, transparent, varies).
ODOR DO NOT SMELL THE WASTE! If the waste has a noticeable odor, then indicate.
PHYSICAL STATE Indicate the physical state at 70 degrees Fahrenheit.
LAYERS Single layer means the waste is homogenous; Multi-layer means the waste is comprised of two or more layers (e.g., oil/water/sludge).
DENSITY  
FREE LIQUID RANGE Range (in percent by volume) of free liquids in the waste.
LIQUID FLASH POINT Indicate the flash point obtained using the appropriate test method.
pH RANGE Indicate the pH range.