WASTE DETERMINATION

Generator Name Generator EPA ID No.

Site Address State Waste stream No.

City State_ ZIP

Waste Name:

Process Generating Waste:

Raw Materials used in Process:

Known Contaminants, Materials, & Chemicals in Process:

Locations where waste is generated:

pH / Specific Gravity / Flash Point (F) / Solids Content
/ / / Free Liquid Range to %
Physical State / Hazardous Characteristics / Odor
/ / / Describe
/ / / Halogens
/ / / Br % Bromine
/ Cl % Chlorine
/ F % Fluorine
/ I % Iodine
Layers: / / /
Top Layer / Second Layer / Bottom Layer / Color
Viscosity / / /
by / / /
Layer: / / /

Is the material Used Oil?

Total Halogens concentration:

SECTION 1 Does the waste meet the definition of Solid Waste?

Is the material being abandoned or disposed of per 40 CFR 261.2(b)

Is the material a secondary recycled material, which is a solid waste per 40 CFR0261.2(c)

Types of secondary materials include / Recycling activities include
·  spent material / ·  use constituting disposal
·  listed sludge / ·  burning for energy recovery
·  sludge exhibiting a characteristic / ·  reclamation
·  listed by-product / ·  speculative accumulation
·  by-product exhibiting a characteristic
·  listed commercial chemical product
·  scrap metal

Is the material inherently waste-like per 40 CFR 261.2(d)

If you answered “Yes” to any of the above, then this waste is a Solid Waste. Please go to Section 2

SECTION 2 Is the Solid Waste a Listed Hazardous Waste?

Process Wastes

Does the waste meet the definition of an F-listed waste per 40 CFR 261.31?

If so, list applicable F-Listed waste code(s)

Does the waste meet the definition of a K-listed waste per 40 CFR 261.32?

If so, list applicable K-Listed waste code(s)

Discarded Products

Is the waste a commercial chemical product with the sole active ingredient listed in 40 CFR 261.33(e)?

If so, list applicable P-Listed waste code(s)

Is the waste a commercial chemical product with the sole active ingredient listed in 40 CFR 261.33(f)?

If so, list applicable U-Listed waste code(s)

Section 3 Does the Solid Waste exhibit a hazardous characteristic?

Does the waste exhibit the characteristic of ignitability per 40 CFR 261.21 (D001)?

·  It is a liquid, and has flash point less than 60°C (140°F), or

·  It is a solid and is capable, under standard temperature and pressure, of causing fire through friction, absorption of moisture or spontaneous chemical changes and, when ignited, burns so vigorously and persistently that it creates a hazard, or

·  It is an ignitable compressed gas, or

·  It is an oxidizer as defined in 49 CFR 173.151.

Does the waste exhibit the characteristic of corrosivity per 40 CFR 261.21 (D002)?

·  It is aqueous and has a pH less than or equal to 2 or greater than or equal to 12.5, or

·  It is a liquid and corrodes steel (SAE 1020) at a rate greater than 6.35 mm (0.250 inch) per year at 55°C (130°F).

Does the waste exhibit the characteristic of reactivity per 40 CFR 261.21 (D003)?

·  It is normally unstable and readily undergoes violent change without detonating. or

·  It reacts violently with water, or

·  It forms potentially explosive mixtures with water, or

·  When mixed with water, it generates toxic gases, vapors or fumes, or

·  It is a cyanide or sulfide bearing waste, or

·  It is capable of detonation or explosive reaction if it is subjected to a strong initiating source or if heated under confinement, or

·  It is readily capable of detonation or explosive decomposition or reaction at standard temperature and pressure, or

·  It is a forbidden explosive as defined in 49 CFR 173.51, or a Class A explosive as defined in 49 CFR 173.53 or a Class B explosive as defined in 49 CFR 173.88.

Does the waste exhibit a toxicity characteristic? (See next page)

aToxicity Characteristic / EPA HW Code / TCLP Limit
(mg/L) / TCLP Result
(mg/L) / Mass Limit
(20 x TC) / Mass result
(as analyzed) / Exceeds
TCLP Limit or
Mass Limit? / Method of Determination
(Analysis/
Process Knowledge) / Date of Analysis /
Metals /
Arsenic / D004 / 5.0 / 100 / /
Barium / D005 / 100.0 / 2000 / /
Cadmium / D006 / 1.0 / 20 / /
Chromium, Total / D007 / 5.0 / 100 / /
Lead / D008 / 5.0 / 100 / /
Mercury / D009 / 0.2 / 4 / /
Selenium / D010 / 1.0 / 20 / /
Silver / D011 / 5.0 / 100 / /
Volatile Organic Compounds /
Benzene / D018 / 0.5 / 10 / /
Carbon Tetrachloride / D019 / 0.5 / 10 / /
Chlorobenzene / D021 / 100.0 / 2000 / /
Chloroform / D022 / 6.0 / 120 / /
1,2-Dichloroethane / D028 / 0.5 / 10 / /
1,1-Dichloroethylene / D029 / 0.7 / 14 / /
Methyl Ethyl Ketone / D035 / 200.0 / 4000 / /
Tetrachloroethylene / D039 / 0.7 / 14 / /
Trichloroethylene / D040 / 0.5 / 10 / /
Vinyl Chloride / D043 / 0.2 / 4 / /
Semivolatile Organic Compounds /
o-Cresol / D023 / 200.0 / 4000 / /
m-Cresol / D024 / 200.0 / 4000 / /
p-Cresol / D025 / 200.0 / 4000 / /
Cresol / D026 / 200.0 / 4000 / /
1,4-Dichlorobenzene / D027 / 7.5 / 150 / /
2,4-Dinitrotoluene / D030 / 0.13 / 2.6 / /
Hexachlorobenzene / D032 / 0.13 / 2.6 / /
Hexachlorobutadiene / D033 / 0.5 / 10 / /
Hexachloroethane / D034 / 3.0 / 60 / /
Nitrobenzene / D036 / 2.0 / 40 / /
Pentachlorophenol / D037 / 100.0 / 2000 / /
Pyridine / D038 / 5.0 / 100 / /
2,4,5-Trichlorophenol / D041 / 400.0 / 8000 / /
2,4,6-Trichlorophenol / D042 / 2.0 / 40 / /
Pesticides /
Chlordane / D020 / 0.03 / 0.6 / /
Endrin / D012 / 0.02 / 0.4 / /
Heptachlor
Heptachlor Epoxide / D031 / 0.008 / 100 / /
Lindane / D013 / 0.4 / 8 / /
Methoxychlor / D014 / 10.0 / 200 / /
Toxaphene / D015 / 0.5 / 10 / /
Herbicides /
2,4-D / D016 / 10.0 / 200 / /
2,4,5-TP (Silvex) / D017 / 1.0 / 20 / /

If the waste exhibits a toxicity characteristic, list all applicable toxicity characteristic waste codes (D004-D043):

If this solid waste is not a Hazardous waste, continue to Section 4 (Is the waste a state –regulated?). If the Solid Waste is a Hazardous Waste, proceed to Section 5 (Is the waste otherwise regulated?)

Is analytical data or an MSDS available that describes the waste?

If yes, please attach.

SECTION 4 – Is the waste subject to other regulatory programs?

Federal Regulations

State Regulations

State(s) where waste is regulated:

List applicable state waste codes and descriptions:

Waste Code / Description

SECTION 5 – Land Disposal Restrictions

Is the waste subject to Land Disposal Restrictions per 40 CFR 268?

Hazardous Waste Code(s) / LDR
Subcategory / Treatment Standards

SECTION 6 – Shipping Information

DOT Proper Shipping Name: .

Hazard Class UN/NA No. PG RQ amt

RQ Description: / 1. / 2.
DOT Description: / 1. / 2.

Waste Codes

GENERATOR CERTIFICATION

______

NAME (PRINT OR TYPE) PHONE DATE

______

SIGNATURE TITLE

Page 6