GENERATOR INFORMATION - Bethlehem Apparatus

[Pages:2]BETHLEHEM APPARATUS

COMPANY

Bethlehem Apparatus Company, Inc.

Bethlehem Apparatus Co., Inc. PH: 610-838-7034 ? FAX: 610-838-6333

890 Front St., P.O. Box Y

E-mail: info@

Hellertown, PA 18055 USA

Internet:

Waste Profile

Shipment No.

GENERATOR INFORMATION

Generator Name: Generator Address:

EPA ID:

Generator Address:

Contact Name:

Email:

Phone: (

)

Fax: (

)

MATERIAL COMPOSITION

MERCURY Steel Glass Plastic Liquid, Non Mercury Other:

RANGE

UNITS, [%.PPM, lbs]

ITEMS INCLUDED

Metal Switches Glass Switches Quartz Lamps Fluorescent Lamps Dental Amalgams PC Boards

Ignitron Tubes Mercury in Soil Telephone Switches Mercury Relays Mercury Batteries Spill Kits

Thermocouples Thermometers Manometers Rectifiers Mercuric Oxide Other:

RCRA METALS CONTENT

Arsenic Barium Cadmium Chromium Lead Mercury Selenium Silver

Content MG/KG

TCLP Test MG/L

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SPECIAL ITEMS Do any of the materials offered for mercury D009 Recovery/Recycling contain any of the following materials or characteristics?

YES

NO If any Yes, then explain:

Aqueous Solutions

Organic Compounds

Reactive Materials

Ignitable Materials

Corrosive Materials

Mercury Compounds Other Than Oxide or Sulfide

Hazardous Characteristics (Other Than Mercury)

PACKAGING MATERIALS

Since packing materials may become contaminated during shipment, it may be necessary to process them as D009 Hazardous Waste. Metal containers or drums made of steel are recommended because or their ease of handling and processing. Anything other than steel will carry and additional processing charge.

Drums 85 gallon Overpack

Quantity

55 gallon, Steel 17H

30 gallon, Steel

20 gallon, Steel

10 gallon, Steel

05 gallon, Steel

Inner Packing

Inner packing materials are not necessary as the entire container is treated as D009 hazardous waste. We request the inner packing material be kept to a minimum. Excessive packing materials of paper and plastic will be charged extra.

GENERATOR'S CERTIFICATION

I hereby certify that all information submitted in this document is true and accurate. All information regarding known or suspected hazards in this material has been disclosed. Generator understands that materials will be accepted fro processing only after: a) Generator has signed a Recovery/Recycling Agreement, b) Generator has received a Merials Acceptance letter, and c) a work authorization number has been issued.

Signature

Printed or Typed Name & Title

Date

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