Hazard Determination Record Form for Chemical Wastes
Use this worksheet to record the results of hazard determination for any chemical waste
suspected of being hazardous. Please fill out a separate worksheet for each waste
generated. Complete all sections of the worksheet, even if you have already identified it
as hazardous.
Generator ________________________Semester and year generated _______________
(can be course, faculty or staff name, or experiment)
Description of the waste
Name of Person Completing the Hazard Determination _______________________
Listed Chemicals
F-list
PCB-containing
Yes
F___________
MN03
No
Non-hazardous
Non-hazardous
Characteristics
1.
Flammability or Combustibility
Yes
D001
D001
D001
Liquid
Solid
Gas
2.
No
Non-hazardous
Non-hazardous
Non-hazardous
Oxidizers
Yes
D001
3.
Corrosivity
Method
pH Indicator paper
pH meter
4.
No
Non-hazardous
pH ≤2 or ≥12
D002
D002
pH 2-12
Non-hazardous
Non-hazardous
Reactivity and Explosiveness
Yes
D003
5.
Toxicity
a. Contaminants listed in Table 1 present? Yes
Contaminant
No
Non-hazardous
No
Concentration (mg/l)
b.
Has the maximum allowable concentration of the contaminant(s) been exceeded? (See Table
1)
Yes
Record the hazardous waste number from
Table 1
6.
No
Non-hazardous
Lethality:
a. List each component and its relevant toxicity data from the MSDS:
b. Calculate the LD50 or LC50 for each component of the mixture using the derivation of
Finney’s formula. Show calculations and record results in appropriate columns below
Component
Proportion
in solution
Oral rat LD50
(mg/kg)
Dermal rabbit
LD50 (mg/kg)
Inhalation rat
LC50
(mg/kg)
LD50 or LC50 for each
component:
Pure substance LD50
%component in solution
c.
7.
Is the sample hazardous with respect to lethality? Yes = MN01 No= Non-hazardous.
Waste Treatment and Disposal
Describe any treatment of the waste designed to minimize the hazard. Record method of waste disposal
used