Generator Waste Material Profile Click here to download a fillable pdf of the form. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.PROFILEProfile numberProfile Type *NewAmendmentTRANSPORTER INFORMATION DESCRIPTION SHIPPING TRANSPORTER Customer Name *Customer Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeName *FirstLastEmail *Phone *EPA ID# *GENERATORGenerator Name *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeTechnical Contact *Title *Name *FirstLastPhone *EPA ID# *WASTE DESCRIPTIONWaste Description *Applicable Manufacturing Category (if any) *CHEMICAL & PHYSICAL STATEChemical and Physical State *LiquidSemi LiquidSolidMultilayeredBilayeredSingle PhasePH *Less than 22 - 44 - 66 - 88 - 1010 - 12Greater than 12N/AOdor *TSS *Color *Flash Point *% Bottoms Sediment *% Debris *% Ash *Specific Gravity *PROCESS DESCRIPTION(Describe process generating waste stream. Include a list of virgin materials and their Material Safety Data Sheets.) *CHEMICAL CONSTITUENTS PERCENTAGE(Must total 100%)Single Line Text *Numbers *Single Line Text (copy)Numbers (copy)Single Line Text (copy) (copy)Numbers (copy) (copy)Single Line Text (copy) (copy) (copy)Numbers (copy) (copy) (copy)TOTAL %TOTALOTHER CONSTITUENTSOther Constituents *METALS (PPM)Arsenic *Lead *Nickel *Cadmium *Magnesium *Tin *Chromium *Mercury *Zinc *Copper *SHIPPING INFORMATIONRCRA Code *Shipping Method *Volume (Gallons) *Submit ACCOUNT MANAGER Name: Matt Gudorf Email: mdgudorf@eco-maxx.comm Phone: 717-545-7950
