Waste Generator Questionnaire

    Generator Information

    Site Information

    Waste Information

    Analytical data attached (file limit: 1.5MB): YesNo

    MSDS attached (file limit: 1.5MB): YesNo

    Waste Type (NO Flammable, Corrosive, Reactive or Toxic Materials)

    Industrial ProcessFood ProcessResidualSludgeOily Waste WaterGround WaterBentoniteSpent Filter MediaSlurryGray WaterGrease Trap WasteSeptageRain WaterOther

    Physical State

    Oil SheenLiquidSludgeSolid

    Quantity of Waste:

    Shipping Information

    Vacuum Straight TruckDewatering BoxVacuum TankerRoll Off ContainerJetVacVacuum Container

    Size of Bulk Load (pick one): 5,0006,0007,000Other

    Per: MonthQuarterYearDayOne TimeOther

    Shipping History

    1. Was this waste stream previously transported for disposal at an approved facility?


    If yes, can you provide us with the facility’s name and the proper shipping name under which the waste was classified?

    Project Duration/Start Date

    1. Intended start date:

    2. Project end date:

    Generator's Certification

    1. Is this waste considered hazardous?


    2. Is this waste generated at a CERCLA/Superfund Site?


    3. Does the waste contain Polychlorinated Biphenyls (PCBs)?


    4. Are there any specific approval, manifesting or reporting requirements for this project?




    By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.