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AUGUSTA-RICHMOND COUNTY LANDFILL GENERATOR’S WASTE PROFILE SHEET Please Print in Ink or Type Waste Profile Sheet Code No. A. WASTE GENERATOR INFORMATION 1. Name: 2. SIC Code: 3. Facility Address (site of waste generation): 4. City, State: 5. Zip/Postal Code: 6. USEPA/Federal ID 7. State ID#: 8. Technical Contact: 9. Phone: B. WASTE STREAM INFORMATION (see instructions) 1. Waste Name: 2. Process Generating Waste: 3. Annual Amount/Units: 4. Type A [ ] Type B [ ] 5. Special Handling Instructions: 6. Incidental Waste Types and Amounts: C. TRANSPORTATION INFORMATION 1. Method of Shipment: [ ] Bulk Liquid [ ] Bulk Sludge [ ] Drum/Box [ ] Other 2. Supplemental Shipping Information: 3. Is this a DOT Hazardous Material? [ ] No [ ] Yes (If Yes, complete 4, 5, and 6) 4. Hazard Class/ID 5. Reportable Quantity/Units (lb/kg): 6. Shipping Name: D. RESPONSIBLE OFFICIAL (Check One) [ ] Approved [ ] Disapproved [ ] Check if additional information is attached If Disapproved, explain: If Approved, continue: 1. Management Methods: 2. Precautions, Conditions, or Limitations on Approval: 3. For Type A wastes, laboratory representative sample was: [ ] Waived [ ] Attached If waived, explain why: Manager Signature: Name (print): (page 1 of 3) Complete pages 2 and 3 (If Type B Special Waste, only complete Part I of Page 2) ---PAGE BREAK--- AUGUSTA-RICHMOND COUNTY LANDFILL GENERATOR’S WASTE PROFILE SHEET (PAGE 2 OF 3) Please Print in Ink or Type E. PHYSICAL CHARACTERISTICS OF WASTE (See Instructions) 1. Color 2. Does the waste have a strong incidental odor? [ ] No [ ] Yes, if so describe 3. Physical State at 70F/21C [ ] Solid [ ] Semi solid [ ] Liquid [ ] Powder [ ] Other 4. Layers [ ] Multi- Layered [ ] Bi-layered [ ] Single- phase 5. Specific Gravity Range: 6. Free Liquids: [ ] Yes [ ] No Volume: 7. pH: [ ] <2 [ ] >2-4 [ ] 7 [ ] 7-10 [ ] 10-<12.5 [ ] >12.5 [ ] Range [ ] N/A 8. Flash Point: [ ] None [ ]<140F/60C [ ] 140-199F/60-93C [ ] >200F/93C [ ] closed cup [ ] open cup F. CHEMICAL COMPOSITION RANGE (MIN-MAX) 1. % % % % % % % Total % 2. Does the waste contain any of the following? PCBs [ ] yes [ ] no [ 50ppm ppm Cyanides [ ] yes [ ] no [ 50ppm ppm Sulfides [ ] yes [ ] no [ 50ppm ppm Please Note: unless analytical results are attached, the chemical composition identification should include, at a minimum, Arsenic, Barium, Cadmium, Chromium, Lead, Mercury, Selenium, Silver, Pesticides, Herbicides, and any other TCLP constituents that may be present in the waste. The total composition must be greater than or equal to 100%. (.0001% = 1ppm = 1mg/l). 3. Indicate method used to determine composition (if provided): [ ] TCLP [ ] Total [ ] Other G. SAMPLING SOURCE: (e.g. Drum, Pit, Pond, Tank, Vat): H. REPRESENTATIVE SAMPLE CERTIFICATION 1. Print Sampler’s Name: 2. Sample Date: 3. Sampler’s Title: 4. Sampler’s Employer (if other than Generator): The Sampler’s signature certifies that any sample submitted is representative of the waste described above pursuant to 40 CFR 261.20(c) or equivalent. 5. Sampler’s Signature: (page 2 of 3) ---PAGE BREAK--- AUGUSTA-RICHMOND COUNTY LANDFILL GENERATOR’S WASTE PROFILE SHEET (PAGE 3 OF 3) I. GENERATOR CERTIFICATION By signing this profile sheet, the generator certifies: 1. This waste is not a “hazardous waste” as defined by US EPA or the State. 2. This waste does not contain regulated radioactive materials or regulated concentrations of PCB’s 3. The information on this sheet and the attachments contain true and accurate descriptions of the waste material. All relevant information regarding known or suspected hazards in the possession of the Generator has been disclosed. 4. The Generator has read and understands the Landfill’s definition of Special Waste included in Part B.5. of the attached instruction form. All types and amounts of special wastes provided in incidental amounts have been identified in Section B.6. of this form. 5. The analytical data presented herein or attached hereto were derived from testing a representative sample taken in accordance with 40 CFR 261.20 or equivalent rules. 6. If any changes occur in the character of the waste, the Generator shall notify the Landfill prior to providing the waste to the Landfill. Signature: Title: Name (type or print): Date: