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Special Waste Disposal Application Form

Kindly complete ALL areas of this form to assist us in facilitating your request. Thank you.

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  • Section A: Generator Information







  • Phone Number
  • Phone Number
  • Phone Number
  • Details RE Waste Transporter







  • Phone Number
  • Phone Number
  • Section B: Waste Stream Information

  • Anticipated Volume / Quantity - Enter the value next to the appropriate measure




  • Section C: Waste Characterization

  • Waste Characteristics- Please indicate which is applicable:



  • Supporting lab analysis

  • Leachability

  • Filename
    Size
    Process
    Status
    • Supporting material safety data sheet (MSDS)

    • Filename
      Size
      Process
      Status
      • Is the waste or any of its components classified as hazardous waste by a recognized authority (e.g. USEPA, EMA)?

      • Section D: Waste Generation Declaration

        Please submit the following statement with your signature as an attachment to your application. Thank you.
      • Declaration

        "I understand that it is the responsibility of the Generator or the Generator’s Authorized Representative to determine the composition and characteristics of the waste described in this application. Additionally, I certify that the information provided is accurate and true to the best of my knowledge."
      • Filename
        Size
        Process
        Status

         

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