Attachment 12 - Facility and Transporter Profile Sheets.pdf

FACILITY PROFILE SHEET

1. Facility Data:

Facility Name:

Address:

Facility Representative(s):

Telephone Number: Fax Number:

Email:

Principle Owner(s):

2. Disposition Services Transporter ID# ___________________________ . (Provide number if transporter has been previously approved by Disposition Services.)

3. For all permits, authorizations, and licenses that authorize the transportation of hazardous waste, provide the following information:

Permitting Authority Permit Number Expiration

Date Country Waste Authorized

4. For each waste that will be processed through the facility, identify the waste, treatment process and CLIN number.

Waste Treatment Process CLIN Number

FACILTY PROFILE SHEET

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Permitting Authority Permit Number Expiration

Date Country Waste Authorized

TRANSPORTATION PROFILE SHEET

1. Transporter Data:

Transporter Name:

Address:

Facility Representative(s):

Telephone Number: Fax Number:

Email:

Principle Owner(s):

2. Disposition Services Transporter ID# ___________________________ . (Provide number if transporter has been previously approved by Disposition Services.)

3. For all permits, authorizations, and licenses that authorize the transportation of hazardous waste, provide the following information:

Permitting Authority Permit Number

TRANSPORTATION PROFILE SHEET

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Permitting Authority Permit Number