Environmental Health and Safety
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A. WASTE DESCRIPTION
Generation Process:
Generation Location: (bldg., room)
Total quantity and/or Estimated Generation Rate:
Department:
Principle Investigator:
B. WASTE PROPERTIES, CHARACTERISTICS, and CONSTITUENTS
Physical State:
pH:
Flash point:
Solid
N/A
N/A
Solids & liquids mixed
≤ 2
< 140 F (60 C)
Liquid
> 2 but < 12.5
> 140 F but < 200 F (93 C)
Single-Layer Multi-Layer
≥ 12.5
> 200 F
Gas
Characteristics:
PCB Content
EPA Listed:
Denote codes below
None
None
D-list
Ignitable
> 5 ppm
F-list
Corrosive
< 5 ppm
K-list
Reactive
P-list
Toxic
U-list
Radioactive
*P and U are discarded commercial chemicals only (virgin)
Composition
Constituent:
Volume %
Constituent:
Volume %
C. ADDITIONAL REMARKS:
(Attach all applicable documentation describing the waste (e.g. process knowledge statement, SDS, sample
analysis, etc.)
D. FINAL DETERMINATION
Hazardous
Non-hazardous
Biomedical
Universal Waste
Used Oil
Prohibited by POTW
Completed by:
Signature:
Date:
Principle Investigator:
Signature:
Date: