Attachment 3 WAF.pdf

NAVFAC Southwest Environmental Services Doc ID: OTH-005 Industrial Waste/Oily Waste Facility Used In: IWOW-03, 08, 22, 27, 67 Bilge & Oily Waste Treatment System Facilities Revision #: 17

Revision Date: 6/14/16

WASTE ACCEPTANCE FORM

/ / JULIAN DATE: ___________________

Transporter’s Co. / Truck # / Driver Name

Bulk Pumping # (Non-FRC): __________________ Activity #: _____ / _

CUSTOMER USE ONLY:

ACTIVITY NAME: BASE waste is coming from:

BUILDING / LOCATION: PHONE NUMBER:

JOB ORDER NUMBER (if available): Base waste is going to: _______________________________________ (Requires manifest if different than base waste is coming from)

WASTE DESCRIPTION:

NBC-NI IWOW HAS THE APPROPRIATE PERMIT(S) FOR, AND WILL ACCEPT, THE WASTE THE GENERATOR IS SHIPPING. [40 CFR 264.12 (b)]

VOLUME (GALLONS):

FRC USE ONLY

BOWSER ID: TANK NO: SHOP NO:

PROCESS GENERATING WASTE: FRC WASTE PROFILE NUMBER:

CB&I PERSONNEL USE ONLY: BULK PROFILE # TRUCK DOI: NOT REQUIRED □ COMPLETED □

FACILITY: IWTP NI ORP NBSD BOWTS NBPL BOWTS NAB BOWTS

NBCNI ONLY: Manifest#: GENERATOR’S ID NUMBER: NON_HAZ

TIME ARRIVED: PUMP START TIME: PUMP END TIME:

PHYSICAL STATE: SLUDGE IN BOWSER/TANKER TRUCK: YES NO VOLUME (GALLONS):

FIELD TEST RESULTS (MG/L), if required (see FRC Profile List):

Total Cr Cr. (VI) CHLOR-D-TECT

CN HYDROCLOR-Q

pH: OTHER

TREATMENT GROUP: 1 – OW/GIW 2 – CONTAMINATED OW/GIW

3 – CHROME 4 – MIXED METALS

5 – CYANIDE 6 – PHENOL

7 – SPECIAL

TREATMENT TANK: BATCH NUMBER: TRACKING NUMBER:

MANAGEMENT METHOD CODE H135______

ACTIVITY REPRESENTATIVE:

PRINT NAME DATE

CB&I REPRESENTATIVE:

PRINT NAME DATE

CB&I TRUCK AUTHORIZATION:

PRINT NAME DATE Time WAF Issued

Total Truck Hours (Pac Trans):

Total Truck Hours over 4:

Note:

NAVFAC Southwest Environmental Services Doc ID: OTH-005 Industrial Waste/Oily Waste Facility Used In: IWOW-03, 08, 22, 27, 67 Bilge & Oily Waste Treatment System Facilities Revision #: 17

Revision Date: 6/14/16

INSTRUCTIONS FOR COMPLETING WASTE ACCEPTANCE FORM

Waste Acceptance Form must accompany all wastewater shipments sent to the Environmental Service Centers: Industrial Waste Treatment Plant, Oily Waste Treatment Plant, or any of the BOWTS facilities. Instructions on how to complete the top, customer portion of the form follow:

TRANSPORTER INFORMATION: Must be filled out by the Operator.

JULIAN DATE: Written by waste receiving facility (needs to correspond with receive date of waf).

Bulk Pumping # (Non-FRC) (For Pac Trans ONLY): Have the driver or customer record the bulk pumping number or the individual contract number for the load being delivered.

ACTIVITY #: Will be assigned by Scheduler.

CUSTOMER USE ONLY (TOP BOX): Must be filled out by the customer or driver and will include the following information:

DATE: Date of the waste shipment.

ACTIVITY NAME: Enter activity name. (e.g. PWC Code 007 or vessel name).

BASE: Base where waste was generated. (e.g. Miramar).

PHONE NUMBER: Phone number for activity representative.

JOB ORDER NUMBER (if applicable): Waste disposal billing Job Order Number.

WASTE DESCRIPTION: In this field write a brief, specific description of the waste such as Chrome Plating Rinse Tank Water.

VOLUME: Record total number of estimated gallons.

FRC USE ONLY: Only FRC will fill out this section.

BOWSER ID: Id for the individual bowser delivering the waste.

SHOP NUMBER: Building or shop number from where the waste was derived.

TANK NUMBER: Tank from which the waste was derived.

PROCESS GENERATING WASTE: General description of the waste.

FRC WASTE PROFILE NUMBER: Profile number assigned by FRC composed of 3 letters and 5 numbers (e.g., IWW13-201)

CB&I PERSONNEL USE ONLY: Only CB&I personnel will fill out this section.

BULK PROFILE NUMBER: Profile number comprised of 2 letters and 2 numbers.

INDUSTRIAL WASTE PROFILE NUMBERS

PROFILE NUMBER WASTE STREAM

HW11 Cyanide Waste HW21 Caustic Only, pH > 12.5 HW31 Acidic Only, pH ≤ 2 HW41 Mixed Metal Waste HW51 Chrome Waste HW61 Phenol and Organic Waste HW71 Special Waste

OILY WASTE/GENERAL INDUSTRAIL WASTE (GIW) PROFILE NUMBER

NW21 GIW

NW91 AFFF without OW/White Water NW93 Ground Water/Rain/Comp Water HW91 Oil/Bilge/Oily Water/AFFF NW61 Other Non Hazardous Waste

TRUCK DOI: Choose if a truck DOI was required or not required. Required when a truck is offloading waste from vessel to shore (over water).

FACILITY: Choose disposal location for the identified waste stream.

MANIFEST # (NBCNI ONLY), EPA Generator ID #, NON_HAZ: If a manifest is used for transport, fill in these sections with the manifest number (located in box 4), Generator’s ID Number (located in Box 1), Non-hazardous Manifest ID number (located in box 1).

TIME ARRIVED: The time the bowser or tanker truck arrived on site.

PUMP START TIME: The time the bowser or tanker truck started pumping.

PUMP END TIME: The time the bowser or tanker truck finished pumping.

PHYSICAL STATE: Liquid or Solid.

SLUDGE IN BOWSER/TANKER TRUCK: Inspect bowser or tanker truck and record if sludge is present.

VOLUME (GALLONS): Total volume in gallons of the waste shipment.

FIELD TEST RESULTS (IF REQUIRED): For OW, Clor-D-Tect or Hydro-Clor. For IW, review FRC Profile List for required testing. Record field test results on WAF.

TREATMENT GROUP: Mark treatment group.

TREATMENT TANK: Record the Tank Number of where the waste was pumped into.

BATCH NUMBER: For IW only, record the batch folder number for the tank that the waste is being disposed into.

TRACKING NUMBER: Record the tracking number from the current month’s Waste Acceptance Tracking Log.

MANAGEMENT METHOD CODE: All waste streams accepted at the IW and OW facilities use the Management Method Code of H135 (discharge to sewer/POTW or NPDES (with prior storage – with or without treatment).

ACTIVITY REPRESENTATIVE: Name of rep from activity CB&I REPRESENTATIVE: Signed by Operator when truck comes back to plant CB&I TRUCK AUTHORIZATION: Signed by Operator issuing waf and inspecting truck TIME WAF ISSUED: Written at time of truck inspection. (FRC bowsers do not undergo pre-transport inspections) TOTAL TRUCK HOURS (CONTRACTOR ONLY): Operator to record total truck hours for all Contractor offloads TOTAL TRUCK HOURS OVER FOUR (4): Operator to record total Contractor truck hours over the allotted 4 hour period

The bottom of the form must be signed and dated by a representative of the generating activity. If you have any questions about how to complete the Waste Acceptance Form, please contact EPS, Operations Officer or Plant Supervisors.

FOR REFERENCE PURPOSES

Page 2 – Instructions for Waste Acceptance Form

TREATMENT TANK: BATCH NUMBER: TRACKING NUMBER: