NON-HAZARDOUS WASTE PROFILE
Submit original profiles only. Submit typed or printed profile with analytical and a one (1) liter representative sample of waste.
GENERATOR DETAILS:
Shaded fields MUST be completed prior to acceptance of waste by RPR Environmental.
Generator Name.
MOE Generator Registration No.
Type of Industry / Business:
Site Address:
Mailing Address (if different):
Contact:
Phone:
Ext:
Fax:
Alternate Contact:
Phone:
Ext:
Fax:
CUSTOMER DETAILS (Billing Purposes):
Customer:
Mailing Address:
Contact:
Check box if same as Generator
Phone:
Ext:
Fax:
WASTE COMPOSITION/CHARACTERIZATION/ PROOF OF CLASSIFICATION (Reg. 2.2.1) [SOR/2014-152]
Common Name of the Waste
Current MOE Class Code (If Registered Under Reg. 347):
LDR Primary Hazardous Waste Number
Additional LDR Haz. Waste Number(s) (if applicable)
TDGA Shipping Name
Primary Hazard Class:
Packing Group (I,II,III)
Generating Process (detailed description):
Waste is:
Unused Raw Materials
Spent
UN #
Subsidiary Hazard Class:
Off-Spec Product
COMPOSITION OF WASTE:
List all chemicals/compounds. Provide MSDS’s or analytical data if available. Check box if MSDS provided.
%
Chemicals/Compounds
%
Chemicals/Compounds
RPR Environmental
WASTE PROFILE
Page 2
PHYSICAL PROPERTIES OF WASTE (21°C):
Physical State: (Please check box)
Solid
Liquid
Gas
Phases/Layers: (#, ie. 1, 2, 3)
Liquid %
Sludge %
Solid %
Powder %
Viscosity:
Low
Medium
High
Pumpable:
Yes
No
Pourable:
Yes
No
Colour:
pH:
2.1 - 7
7.1 - 12.4
NA
2
 12.5
Specific Gravity:
0.8
0.8 - 1
1.1 - 1.7
>1.7
BTU/lb:
5,000 – 10,000
 5000
 10,000
Describe Odour:
Odour:
Strong
Mild
None
Flash Point (FP)
FP < 22.8°C & BP <37.8°C
FP < 22.8°C & BP>37.8°C
FP 22.9°C-<37.8° & BP N/A
(closed cup) &
Boiling Point
FP 37.8°C - 60°C & BP N/A
FP 60°C - 93.3°C & BP N/A
FP > 93.3°C & BP N/A
(BP):
REACTIVITY / HAZARDOUS CHARACTERISTICS
Is this waste any of the following? (Please ensure that at least one box is checked)
Explosive
Pyrophoric
Ignitable Solid
Shock Sensitive
Oxidizer
Air Reactive
Water Reactive
Polymerizable
Radioactive
Biological
Asbestos
Activated Carbon
Reactive Cyanide
Reactive Sulfide
Nitro Cellulose / Lacquer Dust
None of the Above
Other (Please Describe)
SHIPPING INFORMATION
Shipping Volume (per shipment):
Frequency:
Container Type:
Week
Drums
Roll-Offs
Month
Totes
Tankers
Year
Luggers
Vac Trucks
ATTACHMENTS
Please check documentation included as attachments for this waste stream
Sample
Profile Only
Analysis (if yes, please specify)
TCLP (Reg. 558)
Other (please specify):
Material Safety Data Sheet (MSDS)
LEP (Reg. 347)
GENERATOR CERTIFICATION
As an employee and authorized representative of the Generator, I hereby certify that information contained in this
profile is a complete and accurate representation of all known and/or suspected hazards of the material(s)
described. I declare that the contents of this consignment are fully and accurately described above by the proper
shipping name, are classified, packaged and have dangerous goods safety marks affixed or displayed on them,
and are in all respects in proper condition for transport according to the Transportation of Dangerous Goods
Regulations.
.
NAME & TITLE
SIGNATURE
DATE
RPR Environmental
WASTE PROFILE
Page 3
Check the “No” box to confirm each of the hazardous constituents are below the regulatory values for Non-Hazardous waste as per
Schedule 4 (Reg. 347/558). Signing of this certification does not guarantee acceptance of waste without analytical results (TCLP) to
support generator knowledge of waste. If any of the below constituents are above the regulatory limits; you must check “Yes” and refer/
and complete a Hazardous Waste Profile form.
INORGANICS (METALS & ANIONS)
Arsenic
Barium
Boron
Cadmium
Chromium
Cyanide
Fluoride
Lead
Mercury
Nitrate + Nitrite (as Nitrogen)
Selenium
Silver
Uranium
DIOXINS & FURANS
Dioxins & Furans
mg/L
Yes
No
2.5
100.0
500.0
0.5
5.0
20.0
150.0
5.0
0.1
1000.0
1.0
5
10.0
mg/L
CERTIFICATION
Based upon my knowledge of the waste and the process
generating the waste, these constituents are not present in the
waste above hazardous classification levels.
Signed ________________________________
Title
Yes
No
________________________________
CERTIFICATION
0.0000015*
*Toxic Equivalent (TEQ)
Based upon my knowledge of the waste and the process
generating the waste, these constituents are not present in the
waste above hazardous classification levels.
Signed ________________________________
Title
VOLATILE ORGANIC COMPOUNDS (VOC’S)
Benzene
Carbon Tetrachloride
Chloroform
1,2-Dichlorobenzene
1,4-Dichlorobenzene
1,2-Dichloroethane
1,1-Dichloroethylene
Dichloromethane
Tetrachloroethylene
Trichloroethylene
Vinyl Chloride
EXTRACTABLE ORGANICS
Benzo(a)pyrene
Cresol
m-Cresol
o-Cresol
p-Cresol
2,4-Dinitrotoluene
Methyl ethyl ketone
Nitrobenzene
Pentachlorophenol
Pyridine
2,3,4,6-Tetrachlorophenol / (2,3,4,6-TeCP)
2,4,5 – Trichlorophenol (2,4,5 – TCP)
2,4,6-Trichlorophenol (2,4,6-TCP)
2,4-DCP
Mg/L
Yes
No
0.5
0.5
10.0
20.0
0.5
0.5
1.4
5.0
3.0
5.0
0.2
Mg/L
0.001
200.0
200.0
200.0
200.0
0.13
200.0
2.0
6.0
5.0
10.0
400.0
0.5
90.0
________________________________
CERTIFICATION
Based upon my knowledge of the waste and the process
generating the waste, these constituents are not present in the
waste above hazardous classification levels.
Signed ________________________________
Title
Yes
No
________________________________
CERTIFICATION
Based upon my knowledge of the waste and the process
generating the waste, these constituents are not present in the
waste above hazardous classification levels.
Signed ________________________________
Title
________________________________
RPR Environmental
WASTE PROFILE
PESTICIDES & HERBICIDES
Aldicarb
Aldrin + Deldrin
Atrazine
Azinphos-methyl
Bendiocarb
Bromoxynil
Carbaryl / Sevin/ 1-Naphthyl-N Methy Carbamate
Carbofuran
Chlordane
Chlorpyrifos
Cyanazine
2,4-D / (2,4-dichlorophenoxy) acetic acid
DDT (total isomers)
Diazanon
Dicamba
Diclofop-methyl
Dimethoate
Dinoseb
Diquat
Diuron
Endrin
Glyphosate
Heptachlor + Heptachlor Epoxide
Hexachlorobenzene
Hexachlorobutadiene
Hexachloroethane
Lindane
Malathion
Methoxychlor
Methyl Parathion
Metolachlor
Metribuzin
Paraquat
Parathion
Phorate
Picloram
Simazine
2,4,5-TP (2,4,5-Trichlorophenoxy) priopionic acid
Temephos
Terbufos
Toxaphene
Triallate
Triafluralin
PCB’s
Polychlorinated Biphenyls
mg/L
Yes
Page 4
No
0.9
0.07
0.5
2.0
4.0
0.5
9.0
9.0
0.7
9.0
1.0
10.0
3.0
2.0
12.0
0.9
2.0
1.0
7.0
15.0
0.02
28.0
0.3
0.13
0.5
3.0
0.4
19.0
90.0
0.7
5.0
8.0
1.0
5.0
0.2
19.0
1.0
1.0
28.0
0.1
0.5
23.0
4.5
mg/L
CERTIFICATION
Based upon my knowledge of the waste and the process
generating the waste, these constituents are not present in the
waste above hazardous classification levels.
Signed ________________________________
Title
Yes
No
________________________________
CERTIFICATION
0.3
Based upon my knowledge of the waste and the process
generating the waste, these constituents are not present in the
waste above hazardous classification levels.
Signed ________________________________
Title
OTHER COMPOUNDS
Nitrilotriacetic Acid (NTA)
Nitrosodiummethylamine (NDMA)
mg/L
40.0
0.0009
Yes
No
________________________________
CERTIFICATION
Based upon my knowledge of the waste and the process
generating the waste, these constituents are not present in the
waste above hazardous classification levels.
Signed ________________________________
Title
________________________________