seamless@grandforksgov.com
724 North 47th St Grand Forks ND 58203
(701) 738-8740
Grand Forks Public Works Department 724 North 47th Street, Grand Forks ND 58203 Telephone: 701-738-8740 Fax: 701-738-8749
CITY OF GRAND FORKS LANDFILL GENERATOR'S WASTE PROFILE FORM
In order for us to determine whether we can lawfully and safely manage your waste material, we must obtain certain information about the chemical and physical properties of the waste, and its chemical composition and regulatory status. Please answer each question as completely as possible by checking the appropriate boxes or listing in the blanks, or attaching additional sheets as necessary. The Generator or Authorized Representative must sign the form. All related analyses must be included with the form and if future analyses differ from what was submitted, it must be sent to us immediately. Originals must follow fax copies.
Generator Full Address
Code of Federal Regulations (CFR) may be found at https://www.govinfo.gov/app/collection/cfr/
Odor of Waste
Phases of Waste
Corrosivity of Waste
Viscosity (Similar to)
Specific Gravity
Total Suspended Solids (% wt)
Physical State
Ignitability (closed cup)
Pertaining to Waste, please check all that apply:
Is the waste a hazardous waste as defined in Part 261 Sections 261.31 (F Code), 261.32 (K Code), 261.33 (P or U Codes)?
Is the waste characteristically hazardous per Part 261 Sections 261.21-24 (D Codes)? Attach analysis if applicable
Upload Analysis File(s)
Is the waste from an UST corrective action under 40 CFR Part 280?
Is the waste specifically excluded from hazardous waste regulations per Part 261 Section 261.4? If so, attach an explanation including the applicable portion of the regulation
Is the waste being legally treated for a single hazardous characteristic? If so, attach a copy of the Agency notification and a certificate that no Underlying Hazardous Constituents (UHC's) are present
Is the waste from a CERCLA project, in response to a Compliance Order, or a hazardous waste in another state OR subject to Land Disposal Restrictions?
Does the waste contain regulated quantities of radioactives or PCBs? (Attach analyses if applicable)
Do you have supporting documents or testing results to upload?
Upload File(s)
I hereby certify that I am the Generator or authorized by the Generator identified herein to provide the information submitted in this form and any attached documents and to enter into this Agreement on the Generator's behalf. I have made a comlete and thorough investigation of all matters relevant to completion of this form. This investigation included laboratory analysis, where applicable, and was performed in accordance with 40 CFR Part 261 Section 261.20(c) on a representative sample of the ("Waste"). All required information concerning the Waste, including the results of all laboratory analyses has been provided in this and the attached documents. Such information is complete and accurate and that all known or suspected hazardous constituents/characteristics or safety hazards associated with the Wate have been disclosed herein. If I become aware that the analysis is not representative, that the waste has changed, or that the process has changed such that the waste characteristics are substantially different I will notify the landfill facility and the hauler and I will amend the Generator's Waste Profile Sheet as soon as practicable.
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Signatory Information
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