Hazardous Waste Determination Form for Construction, Demolition, or Renovation Project: Waste Description: Generation Process: Estimated Estimated Generation Rate: Quantity: Waste Properties, Characteristics, and Constituents Physical State pH 2 Flashpoint □ ≤ > 2 but 5.5 □ ≤ Solid < 140 ºF □ □ Not Applicable 5.5 but 9.0 □ □ ≥ ≤ w/free standing or absorbed liquid < 140 but < 200 ºF □ □ 9.0 but 12.5 □ ≥ ≤ Liquid > 200 ºF □ □ Unknown 12.5 □ □ ≥ Gas □ Asbestos PCB Characteristics Metals Content Content Content Arsenic Copper □ □ Corrosive None None Barium Lead Silver □ □ □ □ □ □ Cadmium Mercury Zinc Ignitable Friable < 5 ppm □ □ □ □ □ □ Chromium Molybdenum Other (note) Reactive Non-Friable > 5 ppm □ □ □ □ □ □ Cobalt Nickel None Radioactive unknown □ unknown □ □ □ □ □ Composition Constituent Volume % (range) Constituent Volume % (range) Lab Results (if any) Hazard Classification EPA Waste Codes: Non-Hazardous (Solid Waste) □ RCRA Waste (Hazardous Waste) □ TSCA Waste (Universal Waste) □ Regulated Waste □Other Comments: Certification Signing certifies that based on your process knowledge or records on file all information on this form is complete and accurate. Signature Date: Printed initials: Organization Telephone
Hazardous Waste Determination Form for Construction, Demolition, or Renovation Project: Waste Description: Generation Process: Estimated Generation Rate: Estimated Quantity: Waste Properties, Characteristics, and Constituents Physical State □ Solid □ w/free standing or absorbed liquid □ Liquid □ Gas pH □ ≤ 2 □ > 2 but ≤ 5.5 □ Not Applicable □ ≥ 5.5 but ≤ 9.0 □ ≥ 9.0 but ≤ 12.5 □ Unknown □ ≥ 12.5 Flashpoint □ < 140 ºF □ < 140 but < 200 ºF □ > 200 ºF Characteristics □ Corrosive □ Ignitable □ Reactive □ Radioactive Asbestos Content □ None □ Friable □ Non-Friable □ unknown PCB Content □ None □ < 5 ppm □ > 5 ppm □ unknown Metals Content □ Arsenic □ Copper □ Barium □ Lead □ Silver □ Cadmium □ Mercury □ Zinc □ Chromium □ Molybdenum □ Other (note) □ Cobalt □ Nickel □ None Composition Constituent Volume % (range) Constituent Volume % (range) Lab Results (if any) Hazard Classification □ Non-Hazardous (Solid Waste) □ RCRA Waste (Hazardous Waste) □ TSCA Waste (Universal Waste) □Other Regulated Waste EPA Waste Codes: Comments: Certification Signing certifies that based on your process knowledge or records on file all information on this form is complete and accurate. Signature Printed initials: Date: Organization Telephone
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