Waste Profile Form



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Peoria Disposal Company

Environmental Management Facility


Wastestream Approval

Package
Waste Profile Form
*** Please return to PDC only this portion***
Corporate Office Facility

4700 North Sterling Avenue 4349 Southport Road

Peoria, IL 61615 Peoria, IL 61615
Phone (309) 688-0760 Phone (309) 676-4893

Fax (309) 688-0881 Fax (309) 672-2726



Waste Profile Form

PROFILE #      


Please complete this form in its entirety; refer to the Information and Instruction package.


Section 1 - Generator/Customer Information

Generator Name      

Waste Generation Address      

     

City      

St   

Zip      

Mailing Address (if different)      

     

City      

St   

Zip      

Site/Facility Contact      

Phone (       )       -      

Fax (       )       -      

e-mail or other #      

USEPA #      

IEPA #       

SIC code(s)      







Technical Contact      

Company      

Mailing Address      

City      

St   

Zip      

Phone (       )       -      

Fax (       )       -      

e-mail or other #      

Invoicing Info (if different):

Contact      

Company      

Mailing Address      

City      

St   

Zip      

Phone (       )       -      

Fax (       )       -      

e-mail or other #      





Section 2 - Waste Information

Waste Name      

Process generating waste (detailed description)      

     

     

Annual Volume      

Type (i.e., tons, cubic yards, drums,...)      

 Ongoing or  One Time Only

Hazardous Waste Codes (attach separate page if nec.)      

Is this a pollution control waste (35 IL. Adm. Code 858)?  Yes  No

DOT description       

Directions (to site from nearest major hwy.)      

     

     



Section 3 - Physical Data

Key Waste Components (nearest whole number):

     

      %

     

      %

     

      %

     

      %

     

      %

     

      %

     

      %

     

      %

     

100 %







Color (describe)      

Strong odor?  Yes  No

If yes, describe odor.      

     




Does the hazardous waste contain >50% debris

by volume?  Yes  No  N/A

If yes, describe debris (debris is considered to be >2.5 in.)

     

     

     




Section 4 - Analytical Data (to be completed by PDC)


Inorganics




pH

     

Density

      lb/yd3

Flash point

      oF

Paint filter

 Pass  Fail

Total solids

      %

EOX

      mg/kg

Total Cyanide

      mg/kg

Reactive Cyanide

      mg/kg

Amenable Cyanide

      mg/kg

Total Sulfide

      mg/kg

Reactive Sulfide

      mg/kg

Phenolics

      mg/kg

Radioactivity

      CPM

Additional parameters for WASTEWATERS ONLY

Total Chlorine

      ppm

Reid Vapor Pressure

      psi

Bottom Sediment & Water

      % /       %

TOC

      ppm

Oil & Grease

      mg/l




Metals

Characteristic

level

TCLP Analysis

D004 Arsenic

5.0 mg/l

      mg/l

D005 Barium

100.0 mg/l

      mg/l

D006 Cadmium

1.0 mg/l

      mg/l

D007 Chromium

5.0 mg/l

      mg/l

D008 Lead

5.0 mg/l

      mg/l

D009 Mercury

0.2 mg/l

      mg/l

D010 Selenium

1.0 mg/l

      mg/l

D011 Silver

5.0 mg/l

      mg/l

(other) Nickel




      mg/l

Antimony




      mg/l

Beryllium




      mg/l

Thallium




      mg/l

Vanadium




      mg/l

Zinc




      mg/l

Additional metals for WASTEWATERS ONLY (totals)

Copper




      mg/l

Iron




      mg/l

Manganese




      mg/l

Molybdenum




      mg/l

Zinc




      mg/l



















Organics

HW #1

Characteristic level (mg/l)

TCLP Analysis

D018 Benzene

0.5

      mg/l

D019 Carbon Tetrachloride

0.5

      mg/l

D020 Chlordane

0.03

      mg/l

D021 Chlorobenzene

100.0

      mg/l

D022 Chloroform

6.0

      mg/l

D023 o-Cresol

200.04

      mg/l

D024 m-Cresol

200.04

      mg/l

D025 p-Cresol

200.04

      mg/l

D026 Cresol (total)

200.04

      mg/l

D0162,4-Dichlorophenoxyacetic acid

10.0

      mg/l

D027 1,4-Dichlorobenzene

7.5

      mg/l

D028 1,2-Dichloroethane

0.5

      mg/l

D029 1,1-Dichloroethylene

0.7

      mg/l

D030 2,4-Dinitrotoluene

0.133

      mg/l

D012 Endrin

0.02

      mg/l

D031 Heptachlor & its epoxide

0.008

      mg/l

D032 Hexachlorobenzene

0.133

      mg/l

D033 Hexachlorobutadiene

0.5

      mg/l

D034 Hexachloroethane

3.0

      mg/l

D013 Lindane

0.4

      mg/l

D014 Methoxychlor

10.0

      mg/l

D035 Methyl Ethyl Ketone

200.0

      mg/l

D036 Nitrobenzene

2.0

      mg/l

D037 Pentachlorophenol

100.0

      mg/l

D038 Pyridine

5.03

      mg/l

D039 Tetrachloroethylene

0.7

      mg/l

D015 Toxaphene

0.5

      mg/l

D040 Trichloroethylene

0.5

      mg/l

D041 2,4,5-Trichlorophenol

400.0

      mg/l

D042 2,4,6-Trichlorophenol

2.0

      mg/l

D017 2,4,5-TP (Silvex)

1.0

      mg/l

D043 Vinyl Chloride

0.2

      mg/l


1 - Hazardous waste number

2 - Chemical abstracts service number (not listed on profile form)

3 - Quantitation limit is greater than the calculated regulatory level. The quantitation limit therefore becomes the regulatory level.

4 - If o-, m-, and p-Cresol concentrations cannot be differentiated, the total cresol (D026) concentration is used. The regulatory level of total cresol is 200 mg/l.




Section 5 - Certifications

A. Wastestream Certification - Are the following constituents associated with the generation of this wastestream?: Yes No RCRA Pesticides / Herbicides

Polychlorinated Biphenyls (PCB’s)   Chlordane Lindane 2,4-D

F001 - F005 solvents   Toxaphene Methoxychlor Endrin

Dioxins / Furans   Heptachlor & 2,4,5-TP (Silvex)

RCRA Pesticides / Herbicides:   its epoxide
If marked Yes, analysis must be performed and specific source information provided. Please contact your PDC Technical Support Representative for assistance.




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