Business Activity:
(i.e. hospital, research laboratory, chemical plant, WTE incinerator,
etc.)
Business Location:
(City, State, etc.)
* Contact Person:
Telephone:
* Email Address:
Infectious Medical Waste
PCB's
Chemical Process Sludge
Incinerator Ash
Other
If Other, Please SPECIFY:
Physical Waste Form:
(Solid, Liquid, Sludge, etc.)
Solid Waste Size in Microns (if known):
Water Content in Waste (if known):
Is the Waste Material Classified as Hazardous?:
If Yes, by what CRITERIA?
How Is the Waste Packaged:
(Barrels, plastic bags, boxes, landfill, etc.)
Amount of Waste Generated Per Week/Day/Month:
How is the Waste Currently Disposed Of?: