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Material Characterization/Profile Sheet
Please complete requested information to the best of your knowledge. This profile will serve as a platform to evaluate and determine your materials value for sell, recycle or disposal. During the evaluation of your material, IEA may need to acquire additional information, a sample or a signed material characterization profile sheet from the generator. After the information is evaluated and technology is determined, IEA will contact the generator with a contract for review and confirmation signature.
* Required information.
Company Information
Company Name *
Address *
City * State * Zip Code *
Contact Name *
Contact Title
Email Address *
Phone Number *
NAICS SIC Code
Generator Type
Material Information
Material Name *
Process Generating Material
Material Type *
Sub Category
Source A
Origin
Form B
System Type
*Chemical Composition
(List all Constituents)
Total Composition must equal or Exceed 100%
Chemical Ave % Chemical Ave %
Questions about the Waste Stream
Is this an EPA regulated waste? Yes
If yes list all EPA waste codes that apply
Is this a State regulated waste? Yes
Does this material have a State registration number? Yes
If yes, list all state registration number that applies:
Is this material being imported into the U.S.A? Yes
Does this material contain PCB's? Yes
If yes, give concentration in ppm:
Is this material a Marine Pollutant? Yes
Does this material contain Benzene? Yes
If yes, give concentration in ppm:
Is this material from a CERCLA or State mandated cleanup? Yes
*Physical and Chemical Properties
pH Specific Gravity Flash Point
% Suspended % Dissolved % Settleable
Water Solubility % Ash Btu/lb
Free liquid Range % to %
Physical State (Check which best describes)
Hazardous Characteristics (Check all that applies)
Odor Describe if Odor is Strong
Color
% Bromine (Br) % Chlorine (CL) % Fluorine (Fl) % Iodine (I)
Container Information
Select Container Container Size *
Type
Shipping Frequency *
Additional Information
Material Characterization Certification
By submitting this material characterization sheet I hereby certify that all information submitted and all attached information contains a true and accurate description of this material. I authorize International Environmental Associates, Inc. to evaluate and relinquish all submitted information to their affiliates for determining materials value or disposal technology.
Please review your answers and read the 'Material Characterization Certification' before clicking the 'submit' button.

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Fields marked with a "*" are required Fields.