MATERIAL PROFILE SHEET

Please fill in the form below and sign certifying you have read and understand the following:

I hereby certify that the above and attached information is true and accurate to the best of my knowledge. I certify that the information and sample submitted is representative to the waste stream being considered. I understand that the determination made by AOC regarding the acceptance and pricing of this waste is based on the information and sample I provided and is subject to change if the incoming stream changes.

 
Company Name
 
Facility Address
 
City, State, Zip
 
Technical Contact
 
Position
 
Phone
 
Generator EPA ID No.
 
DOT Shipping Name & Placard
 
Are there any levels of PCB's in this waste


 
Is this waste mixed with hazardous (RCRA) waste?


 
Describe the process that generates this waste
 
Type of waste















 
Shipping Method









 
Physical Constituents
 
Arsenic ppm
 
Cadmium ppm
 
Chromium ppm
 
Copper ppm
 
Lead ppm
 
Nickel ppm
 
Zinc ppm
 
Flash Point
 
Gravity
 
Viscosity
 
pH
*
Certification Signature
*
Verify Code