Form WAG-501-F2
Rev. 4
Bulk Waste Assay Program Profile
For EnergySolutions Use Only
Campaign*/Profile #:
Profile Expiration:
I. Generator Information
(A) Facility Name:
Mailing Address:
Zip Code:
(B) Physical Location:
County:
(C) Nature of Business:
Title:
Phone:
Phone:
Technical Contact:
Phone:
II. Waste Stream Information (per Campaign*)
* Campaign is defined as — a very specific, defined series of activities/operations that contribute to the generation of a specified waste.
Waste stream (see page 3) :
General Plant trash (without
Asbestos)
Construction & Demolition Debris
Resin
Carbon filter media
General Plant Trash containing
Asbestos
Other (specify):
PCB bulk product waste**
Wastewater sludge**
Sewage sludge**
Paint Chip & Blast Grit**
** TCLP metals data required from generator
Does the waste represented by this profile contain —
Non-Friable Asbestos
Friable Asbestos
Petroleum
Soil
Provide detailed description of the waste, site history where waste was collected and reason for disposal in Section IV.
Is the waste:
Hazardous Waste Codes:
Yes
A)
B)
C)
D)
E)
Describe Special Waste Handling Procedures:
No
Ignitable
Corrosive
Reactive
TCLP Hazardous
Listed Hazardous
pH (if applicable):
Flash Point (if applicable):
Physical State:
Solid
Infectious (Y/N):
Percent Solid:
Liquid
Sludge
Quantity of Generation:
Quantity of Disposal:
Frequency of Disposal:
Radioactive (Y/N):
Free Liquids present (Y/N):
Slurry
Type Units:
Frequency of Generation:
Method of shipment:
Color:
Ft3
Tons
One Time
Daily
Monthly
Annually
Lbs
Other
Lbs
Other
Weekly
Other
Type Units:
One Time
Daily
Tons
Ft3
Weekly
Monthly
Other
Annually
Drum
Roll-Off
Container (dumpster, collector box)
Plastic Bags
Truck
Other:
How is waste presently managed?
III. Sample Certification
Is the representative sample collected to prepare this profile and laboratory analysis collected in accordance with U.S.
EPA 40 CFR 261.20(c) guidelines or equivalent rules?
Yes, Attach Sample Data
No
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No Sample Taken
Form WAG-501-F2
Rev. 4
Bulk Waste Assay Program Profile
IV. Include a narrative and a flow diagram of the process that generates the waste. Your explanation must describe the
POTENTIAL contaminants, hazardous constituents, petroleum and physical characteristics of the waste which should justify
your scope of constituents. (attach additional pages if necessary):
This waste does not contain RCRA hazardous or petroleum constituents.
Does this waste contain RCRA hazardous constituents?
Yes
No
Does this waste contain petroleum constituents?
Yes
No
Is this a regulated Radioactive Waste as defined by federal and/or state regulations?
Yes
No
Is this a regulated RCRA waste per 40 CFR 262.11?
Does this waste or generating process contain the following Pesticides and/or Herbicides: Chlordane, Endrin, Heptachlor (and its
epoxides), Lindane, Methoxychlor, Toxaphene, 2,4-D, or 2,4,5-TP Silvex as defined in 40 CFR 261.33?
Does this waste or generating process cause it to exceed OSHA exposure limits from high levels of Hydrogen Sulfide or Hydrogen
Cyanide as defined in 40 CFR 261.23?
Does this waste contain listed hazardous wastes defined in 40 CFR 261.31, 261.32, 261.33, including RCRA F-Listed Solvents?
Yes
No
Yes
No
Yes
No
Yes
No
Does this waste contain 2,3,7,8-Tetrachlorodibenzodioxin (2,3,7,8-TCCD), or any other dioxin as defined in 40 CFR 261.31?
Yes
No
Is this waste generated at a Federal Superfund Cleanup Site?
Yes
No
Does this waste contain Polychlorinated Biphenyls (PCBs) as defined in 40 CFR Part 761?
Yes
No
Is this a regulated Toxic Material as defined by federal and/or state regulations?
Yes
No
Is this a regulated Medical or Infectious Waste as defined by federal and/or state regulations?
Yes
No
VI. Generator Certification
I hereby certify that the information contained herein is a true and accurate description of the waste material being offered for disposal and that by
utilizing this profile, neither myself nor any other employee of the company will deliver for disposal or attempt to deliver for disposal any waste that this
facility is prohibited from accepting by law. I understand that any waste processed via this profile for BWAP is a candidate for municipal waste landfill
disposal. All changes that occur in the character of the waste will be identified by the company and disclosed to this EnergySolutions facility prior to
providing the waste to EnergySolutions. Our company hereby agrees to fully indemnify EnergySolutions against any damages resulting from this
certification being inaccurate or untrue. I further certify that the company has not altered the form or content of this profile sheet as provided by
EnergySolutions. I certify that all waste to be shipped to EnergySolutions as part of this campaign for eventual disposal at BFI-Carters Valley Landfill
(Reg. Number SNL #37-104-0185 EXT.) is not a hazardous waste as defined by 40 CFR Part 261 or TN Rule 1200-1-11-.02.
Check
if additional information is attached. Indicate the number of pages attached.
Authorized Representative Name and Title (printed)
Company Name
Authorized Representative Signature
Date
VII. FOR EnergySolutions USE ONLY
EnergySolutions Waste Decision
Approved under existing profile:
Approved under new profile:
Rejected
Conditions:
Name
Title
Signature
Date
Page 2 of 3
Form WAG-501-F2
Rev. 4
Bulk Waste Assay Program Profile
WASTE STREAM DESCRIPTIONS
The following provides a description of currently approved Waste Streams. If you have waste that does not meet the
following descriptions, please contact your Account Executive for assistance and evaluation for acceptance.
A.
General Plant Trash (without Asbestos)
Plant Trash may include materials in varying quantities such as paper, plastic, wood, glass, cardboard, cloth, rubber,
as well as incidental amounts of metal or building materials. RCRA empty containers are also included under the
Plant Trash. General Plant Trash cannot contain any asbestos (friable or non-friable).
B.
Construction and Demolition Debris
Construction and Demolition Debris is earthen, paving, or structural materials generated during construction or
demolition activities. The waste stream may include soil, dirt, sand, clay, or earthen substrate (including normally
occurring rock/stone and plant material); paving materials such as concrete, asphalt, and underlayment (including
embedded reinforcing bar and wire); cinder block, brick, and poured concrete (including embedded reinforcing bar
and wire); roofing materials; non-friable asbestos; and general rubble associated with construction and demolition
activities, such as wood, paper, plastic, metal, and rock/stone.
C.
Wastewater Sludge
Wastewater Sludge is sludge material from building drains or sumps commercial nuclear power plants. The material
consists of dirt, debris and sediments that have accumulated in low areas of drains or sumps of buildings, in addition
to material collected from the downstream settling ponds. The effluents originate from plant cooling and heating
equipment leaks and may also include some storm water. The effluent is collected in sumps, ponds, and other low
areas of nuclear plants, where the settling sludges are periodically pumped, vacuumed or otherwise removed for
disposal. Approved absorbents, such as polymers or corncob, may be added as necessary by EnergySolutions to
ensure no freestanding liquid is present. TCLP analysis must be submitted to EnergySolutions on each campaign of
waste to ensure that heavy metals do not exist in quantities exceeding RCRA hazardous waste limits.
D.
Resin
Resin is mixed anion and cation bead resin used for water purification in nuclear facilities.
E.
Carbon Filter Media
Carbon Filter Medial is carbon (charcoal) used in plant air purification systems. This waste stream is dry. This waste
stream does not include charcoal from pollution control equipment.
F.
Sewage Sludge
Sewage Sludge is treated sanitary sewage waste (human waste only) generated outside the radiologically controlled
area and accumulated to prevent off-site discharge. The waste should generally contain no freestanding liquids on
receipt at EnergySolutions. TCLP analysis must be submitted to EnergySolutions on each campaign of waste to
ensure that heavy metals do not exist in quantities exceeding RCRA hazardous waste limits.
G.
Paint Chips & Blast Grit
Paint chips are dried flecks of previously applied paint, or overspray, or blasting. This waste stream may also contain
blasting grit. TCLP analysis is performed on each campaign of waste to ensure that heavy metals do not exist in
quantities exceeding RCRA hazardous waste limits.
H.
General Plant Trash containing Asbestos
Plant Trash with Asbestos may include materials in varying quantities such as paper, plastic, wood, glass, cardboard,
cloth, rubber, as well as incidental amounts of metal or building materials and RCRA empty containers contaminated
with asbestos (friable or non-friable).
I.
PCB Bulk Product Waste
Waste consists of assorted metal piping and equipment with incidental quantities of concrete, glass and
plastic that may include paints or coatings manufactured with PCBs.
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