Disposal And Certification Form

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“LIQUID” WASTES
DISPOSAL AND CERTIFICATION FORM
Generator Name: ____________________________
Permit #:
________________
Waste Name: _______________________________ Manifest #:_______________
I certify that the waste described above has been analyzed using the procedures
outlined in 40 CFR 258.28 and does not meet the definition of “Liquid Waste” as
defined in 40 CFR 258.28 (c) (1).
1.)
This material has not been solidifed prior to shipment.
Signature: ____________________ Title:__________________
Date:___________
2.)
This material has been solidified to comply with the requirements of 40 CFR
258.28 and the characteristics of the waste have been unchanged by the
solidification process.
Signature: ____________________
Title:__________________
Date:___________

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