Adem Form 300 - Solid Waste Profile Sheet Page 2
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2SOLID WASTE PROFILE SHEET INSTRUCTIONS
Indicate if the submittal is a new certific ation, recertification, or a modification to a current certification. A modification is a request
for a change in the certification when information relative to the waste stream has changed or additional information is added.
GENERAL INFORMATION
Enter the generating facility's name, 12-digit USEPA Identification Number (if a number has been assigned to this location),
physical address where the waste is generated, including county name, and mailing address.
Enter the name of the facility's contact person along with their official title, telephone number and email address. This should be a
person whom the Department can contact with questions regarding this certification or waste stream.
Enter the name of the company and person making this submission, if different from the generator information. Include the
company's mailing address along with the contact person's telephone number and email address.
WASTE INFORMATION
Enter a description of the process generating this waste stream along with the name of the waste. The description should be
clear and include background or historical information that will enable the Department to determine whether the waste is a
hazardous or non-hazardous waste. General processes (e.g., spill cleanup, plant cleanup, decontami nation, accidental release,
wastewater treatment sludge, contaminated debris) will require additional clarifications to ensure that the waste is properly
classified. For example, wastewater treatment sludge is too generic since this sludge could be hazardous depending on how the
wastewater was generated (e.g., sludge from the treatment of wastewaters from electroplating operations could be F006
hazardous waste).
If the waste is subject to the correctiv e action regulations of 40 CFR Part 280 (Underground Storage Tank Program), include the
UST Facility Identification Number and the UST Incident Number (if applicable). If the waste is contaminated with a petroleum
product, indicate the type of petroleum. Also, indicate if the waste contains PCBs, cyanides, or sulfides by checking the
appropriate box and supply the concentration.
If necessary, attach Material Safety Data Sheets or other documents (e.g., laboratory analysis results) that describe the
composition of the waste.
Please indicate the annual volume for disposal. Place an “X” in the box indicating if the waste is a remediation, CERCLA, or
process waste.
WASTE PROPERTIES
Place an “X” in the box indicating the correct physical state of the waste.
If the waste is a liquid or contains free liquid, include values for percent free liquids, pH, and flash point, plus indicate whether or
not the waste will be solidified prior to disposal. If the wast e is solidified, please identify where the solidification process will ocurr
and the product used for solidification. Please attach a Material Safety Data Sheet for the product, if necessary.
WASTE DISPOSITION
If the waste is foundry waste, indicate whether or not it is being used as fill material in accordance with the requirements of ADEM
Admin. Code R. 335-13-4-.26(3).
Supply the name(s) and permit number(s) of the intended landfill(s).
CERTIFICATION
The certification for submitted information must be signed and dated by an authorized representative of the company.
PROFILE/CERTIFICATION NUMBER
If this is a recertification or a modification to an existing ce rtification, enter the six-digit profile number and the certifi cation number
assigned to this wastestream by the Department.
Mail completed form, pertinent analyses, and applicable fees (specified in Division 1, Chapter 6 (335-1-6) of the ADEM
Administrative Code) to:
Waste Disposal Approvals
Land Division
Alabama Department of Environmental Management
P.O. Box 301463
Montgomery, AL 36130-1463
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