724-703-3020 1 Willow Avenue, Oakdale, PA 15071

724-703-3020

Spent Media ID Form

    GENERATOR INFORMATION

    SPENT MEDIA PROPERTIES AND COMPOSITION
    General Description of Spent Media
    Mesh Size
    Foreign Material
    If yes Explain

    Process Generating Spent Media

    CLASSIFICATION
    Is this a U.S. EPA Hazardous Waste:
    Waste Code
    Is the media a Hazardous Waste as defined by State or local regulations?
    Waste Code
    Generator State Agency Information (if spent media is manifested)
    Agency Name and Address:

    REGULATORY
    Does the spent media exceed the following limits?
    Total adsorbed organic constituents in excess of 35% by weight
    Any adsorbed total metals in excess of the following limits:
    Does the media contain PCB’s in excess of 50 ppm?

    Does the media contain dioxins in excess of 20 ppb?

    Does the media contain pesticides or herbicides?

    Does the media contain sulfur/cyanide-containing compounds?

    Does the media contain Halogenated compounds?

    Is the media subject to land ban regulations?

    SHIPPING INFORMATION


    GENERATOR CERTIFICATION
    I hereby certify that all information on this and all attached documents contain a true and accurate description of the spent media and that the characterization of the spent media and classification of spent media as either a hazardous or non-hazardous waste has been made in accordance with applicable laws. Generator agrees to defend and hold the reactivator harmless from all liabilities claim losses arising out of or relating to any violation by the generator or client of any statute ordinance, regulation, law, or other governmental requirements relating to the proper characterization and classification of the spent media including any applicable regulator requirements pertaining to the generation, storage, and transportation of any spent media.

    *By selecting "I Certify" using any device, means, or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing.