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Home
About
Services
- Marine Services
- Land Services
Forms & Documents
Careers
Contact

Phone : 718-981-4600

Email : dispatch@cwofny.com

Product Profile Form

Company

Address

State

City

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

Type of Oil

2 4 6 Kerosene Diesel Blend Stock(Black Oil) Mineral Transformer Jet A Other

Type of Oil - Other

Characteristics

Color

Appearance

Clear Opaque

Oil: %

Water: %

Sediment: %

Total Halogens-ppm

BTU/lb.

Gravity/API (@60 F)

PCBs: mg/kg

Arsenic: mg/kg

Cadmium: mg/kg

Chromium: mg/kg

Lead: mg/kg

Did load or portion of load originate at a utility?

YES NO

(If this load originates at a utility, you must send in PCB analysis. Max PCB concentration mst be less 2.0 ppm.)

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

YES NO

Shipping Information

Transporter

WJL Corp

Generator Invoice Entity

Proper Shipping Name

Anticipated Volume/Units

Frequency

Daily Weekly Monthly Yearly One Time

Method of Shipment

Bulk Liquid Drum Other

Certification

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.

Signature

Name & Title

Date

Driven by Service, Steered with Integrity