Special Waste Disposal Request
Kansas Department of Health and Environment
Bureau of Waste Management
Waste Reduction, Compliance and Enforcement Section
1000 SW Jackson, Suite 320, Topeka, Kansas 66612-1366
You may email to: kdhe.swda@ks.gov or FAX form to: 785-559-4253
State: Zip Code
Telephone Number:
Please type or clearly print - See page 2 for instructions
I. REQUESTER INFORMATION (This is where the Disposal Authorization letter will be sent.)
Business/Company Name:
Contact Person:
E-Mail Address, if applicable:
Fax Number:
II. POINT/LOCATION OF GENERATION INFORMATION (only if different from the information in Section I above)
State: Zip Code
Name of Property/Owner/Generator:
Physical Address/Location:
Contact Person:
Telephone Number:
III. WASTE INFORMATION - Use back of form if additional space is required
Waste Description:
Process Producing Waste:
Physical Characteristics of Waste:
Quantity for Disposal:
(Please Select One)
Renewal of Previous Authorization: Previous/Current Authorization No: Exp. Date:
Landfill Proposed for Disposal:
Solid Waste Transfer Station Proposed:
I hereby certify that I am a duly authorized representative of the generator identified above. I further certify that, to the best of my
knowledge, the following items
are true:
1. The waste identified for disposal is not a hazardous waste as defined by K.A.R. 28-31-261.
2. All analytical analyses provided are from a Kansas Department of Health and Environment (KDHE) certified laboratory and
are representative of the waste identified for disposal.
3. All information provided in any attached profil
e, re-certification, or other document completed by the authorized representative
accurately characterizes the waste.
4. If this is a renewal, the materials and processes that generate the waste have not changed since the last disposal
authorization indicated above, and the information previously provided to KDHE is still valid.
Signature Printed Name Date
Form sw600-specialwaste.pdf
Safety Data Sheets (SDS) Attached:
Est. Weight:
Permit #:
Per Year/Annually
Cubic Yards
One time Event, up to 6 months
Laboratory Analyses Attached:
click to sign
click to edit
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: kdhe.swda@ks.gov
Special waste is defined by K.A.R. 28-29-3(iii) as: Any solid waste that, because of physical, chemical, or biological
characteristics, requires special management standards due to concerns for owner or operator safety regarding
handling, management, or disposal.
Requester Information - Requester information must be provided for the individual taking responsibility for the waste disposal
request. This could be the actual generator of the waste, or a contractor or consultant managing the waste for a client. KDHE
will e-mail you a copy of the special waste disposal authorization (SWDA) letter as a portable document file (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 SWDA letter. Please note
that you may complete this form on-line at our website. kdheks.gov/waste/forms/solidwaste/sw600-specwaste.pdf
Point of Generation Information - Point of generation information must be provided for the physical location where the waste is
generated. If this information is identical to the information provided in Section I, this section may be left blank or marked
“Same”. This is potential information for phase I environmental assessments, also possible confirmational requirements.
Waste Information - The following information must be provided concerning the waste:
Waste description - Provide a brief description of the waste. For example, “contaminated soil”, “wastewater sludge”, etc.
Process producing waste - Provide a brief description of the process that produced the waste. For example, “sand blast
operation”, “painting operations”, “mandatory/voluntary soil remediation”, “product spill and name of product”, etc. Listed
processes in the 40 CFR 261.31 - 261.32 do not qualify as special waste, nor commercial chemical spills listed in 261.33.
Physical Characteristics of Waste - Provide a brief description of the physical make-up of the waste. What does the waste look
like/smell like: For example, "gray sludge", or "dark soils with petroleum odor", etc. What will the landfill facility see & smell at the
time of disposal?
Quantity for Disposal - Estimate the quantity of the waste for disposal in units of pounds or tons. It is best to slightly overestimate.
If the request is for a onetime event for disposal, indicate "Onetime event” though you may need to make multiple trips to the
landfill for disposal. If a volume is estimated please estimate weight also.
Laboratory Analyses Attached - Indicate whether laboratory analyses performed by a KDHE certified laboratory are attached. 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: kdhe.swda@ks.gov.
Safety Data Sheet (SDS) Attached - Indicate whether an SDS for the waste is attached. If you are using an SDS to support your
determination that the waste is not a hazardous waste, the SDS must be attached.
Renewal of Previous AuthorizationIf you wish to renew a disposal authorization issued in the prior year, please complete this
section with the most recent SWDA number for the waste stream. Be sure to review the previous information (analyses, SDS,
etc.) provided to KDHE to make sure it is still valid. An Amendment to a current/recent SWDA may be acquired with an e-
mail to: kdhe.swda@ks.gov referencing the SWDA number with a brief explanation of what will need amended and why.
Disposal Information - The following information must be provided concerning the disposal site for the waste:
Landfill Proposed for Disposal - Indicate the landfill where you wish to dispose the waste. You should contact the landfill for
tentative approval of acceptance prior to submitting this form.
Solid Waste Transfer Station Proposed - If the waste will be shipped through a transfer station, indicate the name and permit
number of that station. If the waste will be shipped directly to a landfill, leave this line blank or indicate "NA" for not applicable.
V. Certification - The certification statement must be signed by an authorized representative of the generator/owner of the waste.
This may be a consultant or contractor authorized to sign on behalf of the generator/owner of the waste.
Revised 02-25-20