NON-HAZARDOUS WASTE PROFILE Submit original profiles only. Submit typed or printed profile with analytical and a one (1) liter representative sample of waste. GENERATOR DETAILS: Shaded fields MUST be completed prior to acceptance of waste by RPR Environmental. Generator Name. MOE Generator Registration No. Type of Industry / Business: Site Address: Mailing Address (if different): Contact: Phone: Ext: Fax: Alternate Contact: Phone: Ext: Fax: CUSTOMER DETAILS (Billing Purposes): Customer: Mailing Address: Contact: Check box if same as Generator Phone: Ext: Fax: WASTE COMPOSITION/CHARACTERIZATION/ PROOF OF CLASSIFICATION (Reg. 2.2.1) [SOR/2014-152] Common Name of the Waste Current MOE Class Code (If Registered Under Reg. 347): LDR Primary Hazardous Waste Number Additional LDR Haz. Waste Number(s) (if applicable) TDGA Shipping Name Primary Hazard Class: Packing Group (I,II,III) Generating Process (detailed description): Waste is: Unused Raw Materials Spent UN # Subsidiary Hazard Class: Off-Spec Product COMPOSITION OF WASTE: List all chemicals/compounds. Provide MSDS’s or analytical data if available. Check box if MSDS provided. % Chemicals/Compounds % Chemicals/Compounds RPR Environmental WASTE PROFILE Page 2 PHYSICAL PROPERTIES OF WASTE (21°C): Physical State: (Please check box) Solid Liquid Gas Phases/Layers: (#, ie. 1, 2, 3) Liquid % Sludge % Solid % Powder % Viscosity: Low Medium High Pumpable: Yes No Pourable: Yes No Colour: pH: 2.1 - 7 7.1 - 12.4 NA 2 12.5 Specific Gravity: 0.8 0.8 - 1 1.1 - 1.7 >1.7 BTU/lb: 5,000 – 10,000 5000 10,000 Describe Odour: Odour: Strong Mild None Flash Point (FP) FP < 22.8°C & BP <37.8°C FP < 22.8°C & BP>37.8°C FP 22.9°C-<37.8° & BP N/A (closed cup) & Boiling Point FP 37.8°C - 60°C & BP N/A FP 60°C - 93.3°C & BP N/A FP > 93.3°C & BP N/A (BP): REACTIVITY / HAZARDOUS CHARACTERISTICS Is this waste any of the following? (Please ensure that at least one box is checked) Explosive Pyrophoric Ignitable Solid Shock Sensitive Oxidizer Air Reactive Water Reactive Polymerizable Radioactive Biological Asbestos Activated Carbon Reactive Cyanide Reactive Sulfide Nitro Cellulose / Lacquer Dust None of the Above Other (Please Describe) SHIPPING INFORMATION Shipping Volume (per shipment): Frequency: Container Type: Week Drums Roll-Offs Month Totes Tankers Year Luggers Vac Trucks ATTACHMENTS Please check documentation included as attachments for this waste stream Sample Profile Only Analysis (if yes, please specify) TCLP (Reg. 558) Other (please specify): Material Safety Data Sheet (MSDS) LEP (Reg. 347) GENERATOR CERTIFICATION As an employee and authorized representative of the Generator, I hereby certify that information contained in this profile is a complete and accurate representation of all known and/or suspected hazards of the material(s) described. I declare that the contents of this consignment are fully and accurately described above by the proper shipping name, are classified, packaged and have dangerous goods safety marks affixed or displayed on them, and are in all respects in proper condition for transport according to the Transportation of Dangerous Goods Regulations. . NAME & TITLE SIGNATURE DATE RPR Environmental WASTE PROFILE Page 3 Check the “No” box to confirm each of the hazardous constituents are below the regulatory values for Non-Hazardous waste as per Schedule 4 (Reg. 347/558). Signing of this certification does not guarantee acceptance of waste without analytical results (TCLP) to support generator knowledge of waste. If any of the below constituents are above the regulatory limits; you must check “Yes” and refer/ and complete a Hazardous Waste Profile form. INORGANICS (METALS & ANIONS) Arsenic Barium Boron Cadmium Chromium Cyanide Fluoride Lead Mercury Nitrate + Nitrite (as Nitrogen) Selenium Silver Uranium DIOXINS & FURANS Dioxins & Furans mg/L Yes No 2.5 100.0 500.0 0.5 5.0 20.0 150.0 5.0 0.1 1000.0 1.0 5 10.0 mg/L CERTIFICATION Based upon my knowledge of the waste and the process generating the waste, these constituents are not present in the waste above hazardous classification levels. Signed ________________________________ Title Yes No ________________________________ CERTIFICATION 0.0000015* *Toxic Equivalent (TEQ) Based upon my knowledge of the waste and the process generating the waste, these constituents are not present in the waste above hazardous classification levels. Signed ________________________________ Title VOLATILE ORGANIC COMPOUNDS (VOC’S) Benzene Carbon Tetrachloride Chloroform 1,2-Dichlorobenzene 1,4-Dichlorobenzene 1,2-Dichloroethane 1,1-Dichloroethylene Dichloromethane Tetrachloroethylene Trichloroethylene Vinyl Chloride EXTRACTABLE ORGANICS Benzo(a)pyrene Cresol m-Cresol o-Cresol p-Cresol 2,4-Dinitrotoluene Methyl ethyl ketone Nitrobenzene Pentachlorophenol Pyridine 2,3,4,6-Tetrachlorophenol / (2,3,4,6-TeCP) 2,4,5 – Trichlorophenol (2,4,5 – TCP) 2,4,6-Trichlorophenol (2,4,6-TCP) 2,4-DCP Mg/L Yes No 0.5 0.5 10.0 20.0 0.5 0.5 1.4 5.0 3.0 5.0 0.2 Mg/L 0.001 200.0 200.0 200.0 200.0 0.13 200.0 2.0 6.0 5.0 10.0 400.0 0.5 90.0 ________________________________ CERTIFICATION Based upon my knowledge of the waste and the process generating the waste, these constituents are not present in the waste above hazardous classification levels. Signed ________________________________ Title Yes No ________________________________ CERTIFICATION Based upon my knowledge of the waste and the process generating the waste, these constituents are not present in the waste above hazardous classification levels. Signed ________________________________ Title ________________________________ RPR Environmental WASTE PROFILE PESTICIDES & HERBICIDES Aldicarb Aldrin + Deldrin Atrazine Azinphos-methyl Bendiocarb Bromoxynil Carbaryl / Sevin/ 1-Naphthyl-N Methy Carbamate Carbofuran Chlordane Chlorpyrifos Cyanazine 2,4-D / (2,4-dichlorophenoxy) acetic acid DDT (total isomers) Diazanon Dicamba Diclofop-methyl Dimethoate Dinoseb Diquat Diuron Endrin Glyphosate Heptachlor + Heptachlor Epoxide Hexachlorobenzene Hexachlorobutadiene Hexachloroethane Lindane Malathion Methoxychlor Methyl Parathion Metolachlor Metribuzin Paraquat Parathion Phorate Picloram Simazine 2,4,5-TP (2,4,5-Trichlorophenoxy) priopionic acid Temephos Terbufos Toxaphene Triallate Triafluralin PCB’s Polychlorinated Biphenyls mg/L Yes Page 4 No 0.9 0.07 0.5 2.0 4.0 0.5 9.0 9.0 0.7 9.0 1.0 10.0 3.0 2.0 12.0 0.9 2.0 1.0 7.0 15.0 0.02 28.0 0.3 0.13 0.5 3.0 0.4 19.0 90.0 0.7 5.0 8.0 1.0 5.0 0.2 19.0 1.0 1.0 28.0 0.1 0.5 23.0 4.5 mg/L CERTIFICATION Based upon my knowledge of the waste and the process generating the waste, these constituents are not present in the waste above hazardous classification levels. Signed ________________________________ Title Yes No ________________________________ CERTIFICATION 0.3 Based upon my knowledge of the waste and the process generating the waste, these constituents are not present in the waste above hazardous classification levels. Signed ________________________________ Title OTHER COMPOUNDS Nitrilotriacetic Acid (NTA) Nitrosodiummethylamine (NDMA) mg/L 40.0 0.0009 Yes No ________________________________ CERTIFICATION Based upon my knowledge of the waste and the process generating the waste, these constituents are not present in the waste above hazardous classification levels. Signed ________________________________ Title ________________________________
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