Transport Company Phone Number*:
Transport Company Email*:
Permit Number (Industrial wastewater discharge):
Responsible Party Name/Title*:
Responsible Party Phone*:
Description of general activities conducted at generator’s facility*:
eWaste Disposal, Inc. may not require laboratory analysis of wastes that are certified to contain no regulated metals, cyanide, toxic organic compounds, sulfides or chlorinated hydrocarbons.
Generators and Waste Haulers Please Note:
We Cannot accept waste water until the physical characteristics and waste water information has been reviewed and accepted. Please complete the separate physical characteristics and waste description for each waste water interceptor locator at this facility.
GENERATORS PROCESS INFORMATION*: (Detailed description of specific activity which created the waste contained in this interceptor.)
Samples being submitted were taken from (location and ID number):
Check one:*ClarifierTrapHolding TankOther - please describe below
Select One*:LiquidMudSludgeSlurryOther - please describe below
Does the waste contain (or could it contain) any measurable amount of total identifiable CHLORINATED HYDROCARBONS?*:YesNo
Constituent / Concentration (mg./l) - If yes, please list the source and approximate concentrations:
Does the waste contain (or could it contain) any known or suspected TOXIC ORGANIC COMPOUNDS? (Examples: Benzene, Toluene, etc.)?*:YesNo
Could the waste contain SULFIDES in excess of 0.1 mg/l?*:YesNo
Please up-load any additional information regarding this waste stream.
This includes any analytical or MSDS information that is available.