WASTE APPROVAL REQUEST FORM by olliegoblue34

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									                               WASTE APPROVAL REQUEST FORM                                                                    APPROVAL#

                              Castle Environmental, Inc.
                      1750 New Butler Road, Suite A, PA Castle,
                      101 River Park Drive, New Castle, New16101 PA 16101
                      Phone (724)657-8777       Fax (724)657-3457                                                                       RWC #
     FORM # AR-001    Web: www.castleenvironmental.net
GENERATOR INFORMATION                                        WASTE STREAM INFORMATION

Company:                                                             Waste Name:
Address:
City/St/Zip:                                                         Process
County:                                                              Generating
                                                                     The Waste
Contact:
Title:                                                               Anticipated                                  Gallons                        Day          Month        Year
Phone:                                                               Volume                                       Drums
                                                                                                                                  Per            Week         Quarter      ONE TIME
Fax:

BROKER INFORMATION                                                   WASTE CHARACTERISTICS

Company:                                                             Physical State:        Liquid, < 1% Solids             Liquid w/Solids         Heavy Sludge
Address:                                                             Layers:                Single Layer                    Bi-Layered              Multi-Layered
City/St/Zip:                                                         Describe Odor:                                         None                    Mild Odor           Strong Odor
                                                                     Color:
Contact:                                                             Density Range:                                   to
Phone:                                                               Flash Point:
Fax:                                                                 pH:

WASTE COMPOSITION                                                    GENERATOR QUESTIONNAIRE & CERTIFICATION
Component                                 Percentage                 Is this a treatment residue of a waste which was previously a restricted hazardous waste?
                                                                        No    Yes - Describe:
                                                                     Is this a "Hazardous Waste" as defined by State, Provincial, or Local Regulations?
                                                                        No    Yes - Describe:
                                                                     Is this a "Special Waste", an "Industrial Waste", or a "Pollution Control Waste" as defined
                                                                     by State, Provincial, or Local Regulations?
                                                                        No    Yes - Describe:


I hereby certify that the above and attached description is complete and accurate to the best of my knowledge and ability to determine, that no deliberate or willful
omissions of composition or properties exist, that all known or suspected hazards have been disclosed, and that the waste is not a regulated hazardous waste by
USEPA, by an applicable State or Provincial authority, or by any applicable local authority, and does not contain PCB's regulated by TSCA (ie. 40 CFR 761) or any
Provincial authority:


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