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About
Services
- Marine Services
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Forms & Documents
Careers
Contact

Phone : 718-981-4600

Email : dispatch@cwofny.com

Generators Waste Profile Form

Generator Information

Company Name(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Contact Name(Required)

Phone Number(Required)

Site Name(Required)

Site Address(Required)

Site Contact

Cell Phone

Invoice Information

Company(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Contact(Required)

Phone Number(Required)

Fax Number

Email Address(Required)

JOB

Waste Information

Name of Waste(Required)

Process Generating Waste(Required)

Characteristic

Color(Required)

Odor(Required)

Halogens

Physical State

Solid

Liquid

Sludge

Powder

Layers(Required)

Single Phrase

Bi-Layered

Multi-Layered

Emulsified

Flash Point(Required)

<100 F

100 F-140 F

> 140 F

Corrosivity (pH)(Required)

3-5

5-7

7-9

9-12

Actual

Corrosivity Actual(Required)

Chemical Composition

% Water(Required)

% Oil(Required)

% Solid(Required)

Transporters

Transporter 1

Transporter 2

Transporter 3

Was waste generated from a regulated CERCLA/Super Fund Site?

Yes

Did load originate at a utility?

Yes

(If this load originates at a utility, you must send in PCB analysis. Max PCB concentration must be less 2 ppm.)

Does this waste contain greater than 2 ppm PCB's or are PCB's derived from a source greater than 2 ppm?

Yes

Does this waste contain greater than 1000 ppm total HOC (Halogenated Organic Compounds)?

Yes

Manifest Information

Proper Shipping Name(Required)

Anticipated Volume/Units(Required)

Frequency

Daily

Weekly

Monthly

Yearly

One Time

Method of Shipment

Bulk Liquid

Drum

Other

Generator Certification

Consent(Required)

I hereby certify that all information submitted in this and all attached documents is true and accurate, based on my inquiry of those individuals immediately responsible for obtaining this information. I believe that the submitted information is true and complete to the best of my knowledge and that all suspected hazards have been disclosed. I am aware that there are significant penalties for submitting false information including the possibility of fine and imprisonment for knowing violations.

Print Name(Required)

Title(Required)

CAPTCHA

Generator Information

Company

Address

City

State

Zip/Postal Code

Contact

Phone Number

Site Name

Site Address

Site Contact

Cell Phone

Invoice Information

Company

Address

City

State

Zip/Postal Code

Contact

Phone Number

Fax Number

JOB

Waste Information

Name of Waste

Process Generating Waste

Characteristics

Color

Odor

Halogens

Physical State

Solid Liquid Sludge Powder

Layers

Single Phase Bi-Layered Multi-Layered Emulsified

Flash Point

<100 F 100 F-140 F > 140 F

Corrosivity (pH)

3-5 5-7 7-9 9-12 Actual

Chemical Composition

% Water

% Oil

% Solids

Transporters

Was waste generated from a regulated CERCLA/Super Fund Site?

YES NO

Did load originate at a utility?

YES NO

(If this load originates at a utility, you must send in PCB analysis. Max PCB concentration must be less 2 ppm.)

Does this waste contain greater than 2 ppm PCB's or are PCB's derived from a source greater than 2 ppm?

YES NO

Does this waste contain greater than 1000 ppm total HOC (Halogenated Organic Compounds)?

YES NO

Manifest Information

Proper Shipping Name

Anticipated Volume/Units

Frequency

Daily Weekly Monthly Yearly One Time

Method of Shipment

Bulk Liquid Drum Other

Generator Certification

Name & Title

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