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Material Profile Sheet

Please fill in the form below and sign certifying you have read and understand the following:

I hereby certify that the below and attached information is true and accurate to the best of my knowledge. I certify that the information and sample submitted is representative to the waste stream being considered. I understand that the determination made by AOC regarding the acceptance and pricing of this waste is based on the information and sample I provided and is subject to change if the incoming stream changes.

Your Email*

Company Name*

Facility Address*

City,State,Zip*

Technical Contact

Position

Telephone

Generator EPA ID No.

DOT Shipping Name & Placard

Are there any levels of PCB's

Is this waste mixed with hazardous (RCRA) waste?

Describe the process that generates this waste

Type of waste
 Used Oil Virgin product Wastewater Gasoline tank bottoms Diesel tank bottoms Sump sludge Oil dry Oily dirt Gasoline contaminated dirt Diesel contaminated dirt Absorbent rags for used oil Absorbent rags for virgin product Used Oil Filters (uncrushed) Used Oil Filters (crushed) Speciality Filters

Shipping Method
 AOC bob tail truck AOC tanker truck AOC vacuum truck Generator's tanker truck Generator's vacuum truck Third party tanker truck Third party vacuum truck Drums picked up by AOC truck Drums shipped by generator

Physical Constituents

Arsenic ppm

Cadmium ppm

Chromium ppm

Copper ppm

Lead ppm

Nickel ppm

Zinc ppm

Flash Point

Gravity

Viscosity

pH

* Certification Signature

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