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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.

 

A. WASTE GENERATOR INFORMATION

Generator Full Address

B. PROCESS GENERATING WASTE (Based on 40 CFR Part 261)

Code of Federal Regulations (CFR) may be found at https://www.govinfo.gov/app/collection/cfr/

C. WASTE PROPERTIES

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:

D. REGULATORY QUESTIONS (Based on 40 CFR Part 261)

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

Upload Analysis File(s)

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)

Upload Analysis File(s)

E. HANDLING REQUIREMENTS

Do you have supporting documents or testing results to upload?

SUPPORTING DOCUMENTS - TESTING INFORMATION

Upload File(s)

F. AUTHORIZED SIGNATURE

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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