Veolia es technical Solutions, llc

Veolia ES Technical Solutions, LLC
5736 W. Jefferson Street, Phoenix, Arizona 85043

Tel: [phone] Fax: [phone]

Waste Profile Sheet

PCB, PCB-Contaminated, and Non-PCB wastes and equipment

Profile #_____________

Sales Representative: ______________________________ Designated Facility: ________________________________

A. Generator Information B. Billing Information

Name _________________________________ Name _________________________________

Site Address _________________________________ Site Address _________________________________

City, State, Zip _________________________________ City, State, Zip _________________________________

Contact _________________________________ Contact _________________________________

Phone _________________________________ Phone _________________________________

EPA ID# ________________ State ID # ______________________ SIC Code _________________



C. General Information

Name of Waste ________________________________ Process Generating Waste/Description of Equipment___

Estimated Volume ______________________________ ______________________________________________

Frequency _________________________________ ______________________________________________

Method of Shipment:  Drum Type/Size _______  Other packaging description

DOT Proper Shipping Name:

Hazard Class: UN/NA ID#: Packing Group:

US EPA and State Waste Codes: Out of Service Date:

D. Chemical Composition and Characteristics for PCB solids and liquids

Chemical Composition Percent Range Color _________________________________

_________________________ ____________ Physical State _________________________________

_________________________ ____________ Odor  Strong  Mild  None

_________________________ ____________ BTU/lb. _________________________________

_________________________ ____________ Flash Point _________________________________

_________________________ ____________ pH _________________________________

_________________________ ____________ Free Liquids _________________________________

(Total must be greater than or equal to 100%) PCBs


E. Sample Information/Attachments

Check all that apply:

 Laboratory Analysis submitted  Inventory of PCB Articles/Containers attached

Laboratory Name _______________________ Sample Date _____________ Sample I.D. __________________

F. Generator Certifications

1. 
   This waste does not contain and is not a Hazardous Waste as defined by the U.S. EPA in 40 CFR 261.
   
2. 
   This waste does not contain radioactive materials.
   
3. 
   This waste does not contain infectious wastes/regulated medical wastes.
   
4. 
   All information submitted in this and all attached documents contains true and accurate descriptions of this waste. Any sample submitted is representative as defined in 40 CFR 261 - Appendix 1 and was obtained by using this or an equivalent sampling method. All relevant information regarding known or suspected hazards in the possession of the generator has been disclosed.
   

Generator’s Signature ________________________________ Title ________________________________________

Print Name ________________________________ Date ________________________________________

PCB Waste Profile Sheet Instructions

Below is a section by section list of instructions for completing a Veolia ES Technical Solutions PCB Waste Profile Sheet.

Profile Header Information

Profile #: To be assigned by Veolia, please leave blank.

Sales Representative: If not already completed, fill in the name of your Veolia Sales Representative.

A. Generator Information

Enter the generator information in this section as it should appear on the manifest or bill-of-lading. The uniform hazardous waste manifest must contain the generator’s mailing address. Many states also require the entry of the pick-up address, if different from the mailing address. If the pick-up address is different than mailing address, please attach an additional sheet listing the pick up address. All manifest copies and certifications will be mailed to the generator address listed on the profile unless Veolia is notified otherwise. If an alternate address is to be used for the mailing of manifest copies or certificates of recycling please attach an additional sheet noting this address.

B. Billing Information

Enter the information for the party to be billed.

C. General Information

Name of Waste: Enter the common description for the waste being profiled. For electrical equipment, a separate profile form should be completed for each type of equipment and its corresponding PCB level (<50 ppm or Non-PCB, 50-499 ppm or PCB Contaminated, and >499 ppm or PCB). Separate profiles should also be completed for drained equipment versus full equipment.

Process Generating Waste: Enter a description of the process generating the waste. This will typically be “Removal of electrical equipment.” For wastes other than electrical equipment, this information is critical to determining whether Veolia can accept the material and determining what analysis is required for the material. This information must clearly describe the process. An example of an acceptable description would be: “Clean up of release from PCB contaminated transformer original concentration 250 ppm.” An example of an unacceptable description would be: “Spill clean up.” Providing insufficient information in this section may cause unnecessary delays in approving the waste.

Estimated Volume and Frequency: Enter the estimated volume and frequency for waste stream shipments.

Method of Shipment: Enter the type of packaging to be used for the shipment. Other packagings include cardboard boxes, supersacks, cube boxes. If transformers or other electrical equipment is to be shipped as is without placing the piece of equipment into a DOT specification packaging, write “As is equipment” in the other packaging space.

DOT Proper Shipping Name: Enter the DOT Proper shipping to be used to describe the waste on the manifest or bill-of-lading.

Hazard Class, UN/NA ID#, Packing Group: Enter the appropriate hazard class, ID#, and packing group for the material.

US EPA and State Waste Codes: Enter the applicable US EPA and/or State Waste Codes

D. Chemical Composition and Characteristics

Chemical Composition: For PCB solids and liquids enter a description of the constituents that make up the waste stream. This section should be completed with as much detail as possible. An example of an acceptable list of components/constituents:
Soil 10-20%

Cardboard 10-20%

Absorbent Pads 20-30%

Floor Dry 20-30%

Wood 5-10%

Oil – 75 ppm PCBs 5-10%

An example of an unacceptable list of components/constituents:

Debris 95-99%

PCBs 1-5%
Characteristics: Enter a description or analytical results for the parameters listed in this section.

E. Sample Information/Attachments

Attach a copy of any analysis that would apply to the waste stream. If multiple pieces of equipment are being included on one profile, attach an inventory of the electrical equipment. Include the serial number, where available, the concentration of PCBs, the out-of-service date, and the weight (in kg).

The Laboratory name, Sample date and Sample ID must also be entered in this section of the profile for any analysis that is being submitted.

F. Generator Certification

The generator or an agent of the generator must sign this section certifying that the waste does not contain PCBs, Appendix VIII organics, radioactive materials, or infectious waste. The generator is also certifying that all information of the profile is true and accurate and that no information is being with held from Veolia.