Source: http://dentisty.org/waste-profile-form.html?page=2
Timestamp: 2018-12-18 19:44:30
Document Index: 511075399

Matched Legal Cases: ['arts 261', 'art 268', 'art 264', 'art 264', 'art 265', '§ 268', '§ 268', '§ 268', '§ 268']

Waste Profile Form - Page 2
B. Benzene NESHAP - This is applicable only to generators who have one or more of the following SIC codes: 2812 2819 2823 2834 2841 2844 2865 2874 2891 2895 3312
2813 2821 2824 2835 2842 2851 2869 2875 2892 2899 4959
2816 2822 2833 2836 2843 2861 2873 2879 2893 2911 9511
1) Does your operation have one of the SIC codes listed?  Yes  No
If Yes, which code(s)?.
If No, STOP. The Benzene NESHAP Rule does not apply to your waste.
2) Does your facility produce or use more than 10 megagrams (22,000 lb.) of benzene per year?
If Yes, what is the volume?
3) Does your waste contain greater than 10% moisture?  Yes  No
If Yes, what is the approx. moisture content?
4) What is the TOTAL Annual Benzene (TAB) concentration in your waste?_________ _mg/kg
If you answered Yes to question 1), 2), and 3) and the TAB concentration is greater than 10 mg/kg, your waste is subject to the Benzene NESHAP requirements.
C. Empty Container Certification - If this waste contains “RCRA-empty” containers, do the waste containers meet the definition of “RCRA-empty” as stated in 40 CFR 261.7, and are therefore, exempt from regulation under Parts 261 through 265, or Part 268, 270, or 124 of 40 CFR Chapter 1, or to the notification requirements of Section 3010 of RCRA?  Yes  No  N/A
D. Cyanide / Sulfide Certification - For wastes with reactive cyanides or sulfides > 10 mg/kg, has any of the following occurred? Yes No N/A
1) Has the waste ever caused injury to a worker because of hydrogen sulfide (H2S)
and/or hydrogen cyanide (HCN) generation?   
2) Have the OSHA work place air concentration limits for H2S and/or HCN been
exceeded in areas where the waste is generated, stored, or otherwise handled?  
3) Have air concentrations of H2S and/or HCN, above 10 ppm, been encountered
in areas where the waste is generated, stored, or otherwise handled?  
E. Toxic Release Inventory Constituents - Based upon the attached TRI Constituents list table, please identify those constituents which are associated with the generation of your waste and their relative concentrations. This knowledge is based upon:  Generator knowledge  Both
 Analytical data (please attach)  Not required to report
F. Certifications For HAZARDOUS WASTE ONLY:
1) Underlying Hazardous Constituents - Based upon analytical verification and/or knowledge of the process which
generates my waste, it complies with the Underlying Hazardous Constituents concentrations (40 CFR 268.48) of the Land Disposal Restrictions (LDR’s). I have marked ( ) in the UHC list individual constituents of concern reasonably expected to be present at the point of generation. If marked ( ), analytical data on a grab sample has been provided which verifies that these constituents either meet the appropriate LDR standard or are being treated by PDC to meet the appropriate standard.
I have reviewed the UHC list and I:  have indicated on the table the constituents of concern.
 do not have any constituents of concern
2) Subpart CC - Is the waste exempt from the Subpart CC standards found in 40 CFR, Part 264?  Yes  No
This knowledge is based upon either analysis of the waste via Method 25D as noted in EPA
Publication SW-846, “Test Methods for Evaluating Solid Waste, Physical/Chemical Methods”,
or by using process knowledge as indicated below (please check the appropriate statement(s)):
___
1. Organic material balances for the source, process, or waste management unit generating the waste;
2. Documentation that lists the raw materials or intermediate products fed to a process showing that no
organics are used in the process generating the waste;
3. Information that shows the waste is generated by a process that is substantially similar to a process
at the same or another facility that generates a waste that has previously been determined by direct measurement to have a volatile organic content less than the action level (500 ppmw);
4. Test data that provide speciation analysis results for the waste that are still applicable to the current
waste management practices and from which the total concentration of organics in the waste can be computed (generator must provide documentation describing the testing protocol and the means by which sampling variability and analytical variability are accounted for in the determination of the volatile organic concentration of the hazardous waste); or
5. Other knowledge based on manifests, shipping papers, or waste certification notices (organic LDR
For the purposes of documentation on this Waste Profile Form, signatures transmitted by facsimile machine shall be treated in all manner and respects as an ORIGINAL document and shall be considered to have the same binding legal effect as an ORIGINAL document. I hereby agree that I shall not raise as a defense to the formation of this Waste Profile Form the fact that the signature was transmitted through the use of a facsimile machine.
I certify, on behalf of the generator, to the best of my knowledge and belief that this document, including attachments, certifications, and analytical data is complete, accurate, and representative of the waste I will ship to Peoria Disposal Company. I have used intimate knowledge of the process that generates the waste to accurately determine the proper nature and classification of the waste. If there should be any significant changes in the process that generates my waste that would change its regulatory status or characterization, I will immediately notify PDC of these changes. I am aware that there are significant penalties for knowingly submitting false information, including the possibility of fine or imprisonment under Federal law.
Printed name of authorized representative Title
* * * FOR PDC USE ONLY * * *
Method : Facility
WAP Expiration
For Nonwastewater D004-D043, “deactivated” D001-3 wastes and Listed Hazardous Wastes using the 10 X UTS soil allowance
Mark each constituent of concern in the column (see certification).
UTS-Non WW; Total (mg/kg)1
unless noted TCLP
o-Anisidine (2-methoxyaniline)
Benzo(b)fluoranthene (difficult to distinguish from benzo(k) fluoranthene)
Benzo(k) fluoranthene (difficult to distinguish from benzo(b) fluoranthene)
2,4-D (2,4-Dichlorophenoxyacetic acid )
2,4-Dimethylaniline (2,4-xylidine)
1,2-Diphenylhadrazine
EPTC (Eptam) 6
Total PCBs(sum of all PCB isomers; all aroclors)
Xylenes-mixed isomers (sum of o-,m-, and p-xylene concentrations)
Cyanides (Total) 4
Cyanides (Amenable) 4
Mercury - Nonwastewater from Retort
Mercury - All Others
Except for metals (EP or TCLP) and Cyanides (Total and Amenable) the nonwastewater treatment standards expressed as a concentration were established, in part, based upon incineration in units operated in accordance with the technical requirements of 40 CFR Part 264 Subpart O, or 40 CFR Part 265 Subpart O, or based upon combustion in fuel substitution units operating in accordance with applicable technical requirements. A facility may comply with these treatment standards according to provisions in § 268.40(d). All concentration standards for nonwastewaters are based on analysis of grab samples.
Both Cyanides (Total) and Cyanides (Amenable) for nonwastewaters are to be analyzed using Method 9010 or 9012, found in “Test Methods for Evaluating Solid Waste, Physical/Chemical Methods”, EPA Publication SW-846, as incorporated by reference in 40 CFR 260.11, with a sample size of 10 grams and a distillation time of one hour and 15 minutes.
These constituents are not “underlying hazardous constituents” in characteristic wastes, according to the definition at § 268.2(i).
Between August 26, 1996, and March 4, 1998, these constituents are not “underlying hazardous constituents” as defined at § 268.2(i) of this Part.
This constituent is not an underlying hazardous constituent as defined at § 268.2(i) of this part because its UTS level is greater than its TC level, thus a treated selenium waste would always be characteristically hazardous, unless it is treated to below its characteristic level.
Wastestream Approval
* * * Please retain for future reference * * *
4700 North Sterling Avenue 4349 Southport Road
Phone (309) 688-0760 Phone (309) 676-4893
Fax (309) 688-0881 Fax (309) 672-2726