SW650a – updated 06/10/2013 Page 3 of 3
Instructions for Completing the Generator Liquid Waste Profile Sheet
If you have any questions about information required to complete this form, please contact
the Special Waste Coordinator at 785-296-1600 or send an e-mail to: email@example.com
The Kansas Department of Health and Environment would like to emphasize to our landfills participating in the
RD&D program that they must work with their customers to ensure that accurate waste determinations be
made either by following good representative sampling protocols or by knowledge of process both initially and
whenever necessary based upon changes to the waste stream or BWM requirements.
I. Generator Information - Information must be provided for the location where the waste is generated and
by the individual taking responsibility for the waste disposal request. KDHE will e-mail you a copy of the
special waste disposal authorization letter in portable document format (pdf) if you provide your e-mail
address. If you do not provide your e-mail address, we will mail or fax you a copy of the Special Waste
Disposal Authorization (SWDA) letter. Please note that you may complete this form on-line at our website;
however, you must print the form and submit a signed copy via fax, regular mail or as an e-mail
I. Waste Stream Information – Provide 1) the name or a brief description of the liquid waste; i.e., oily
wastewater, wastewater sludge”, etc.; 2) a brief, accurate description/name of the process (es) that
produced the waste, i.e., wastewater treatment plant process, type of industrial wastewater process, etc;
3) the physical state; 4) the method of shipment; 4) estimated annual volume in gallons or liters; 5
requency of generation; 6) special handling instructions; and 7) information regarding prior disposal for
Subtitle D landfill disposal.
I. Representative Sample Certification – All analytical data provided are from a Kansas Department of
Health and Environment (KDHE) certified laboratory and are representative of the waste identified for
disposal. When sampling/analysis is required such as when washing down industrial equipment in
oduction area or a large tank clean-out, it is important for these liquid waste “determinations” to b
ed upon representative samples. This is especially important for large waste streams that have the
potential to change through the course of a project.
V. RD&D Landfill Information – Provide landfill name, address, location and contact details.
Hazardous Waste Determination Information - Provide 1) liquid wastewater characterization
information as defined by pH, flash point, and other process related characteristics; and 2) provide
laboratory analytical report/s and/or Material Safety Data Sheets for all chemicals in the process streams
including the parameters required for this profile. The laboratory reports need to indicate and certify
whether the environmental characterization analyses were performed by a KDHE certified laboratory with
certifications for these types of analyses. If you have questions whether analyses are required or what
analyses are required, please contact the Special Waste Coordinator at 785-296-1600 or send an e-mail
to: firstname.lastname@example.org. Also, provide answers to the five questions regarding waste type
characterization at the end of this section.
. Certifications (Generator and Landfill) - The certification statement must be signed by an authoriz
epresentative of the generator/owner of the waste as well as the landfill.