Hazardous Waste Determination Form

Generators of hazardous waste are required to evaluate the characteristics and chemical components of any waste stream by completing a "Hazardous Waste Determination." Follow the listed steps and complete the form:

Determine if the waste is hazardous. A waste is anything that is spent, discarded, abandoned, recycled, put down the drain, treated on site or is considered inherently waste-like. Wastes can be solid, semi-solid, liquid, or contained gases or any combination.
Is the waste excluded from hazardous waste regulations?
Is the waste a listed waste?
Does the waste exhibit any characteristics?

Risk Management and Safety has developed a tool to assist generators with this determination. Please reach out to RMS at 702-895-2929 for assistance with completing the form.

* indicates a required field

Basic Information

* PI Name:

* PI Phone Number:

* PI Email:

* Building:

* Room/Location:

Waste Determination Name:

Waste Process Description

Waste Description (Including Chemical/Physical Description):

* Process Generating the Waste:

Waste Physical State:

Waste pH:

Waste Composition

Chemical Name: Percentage:

Chemical Name	Percentage	Remove

Waste Stream Determination

Waste Determination Based On:

Describe the Analytical Process used in the Waste Determination:

Waste Determination Date:

"Solid Waste" Exemption §261.2

Specify "Solid Waste" exclusion or exemption by regulatory citation and describe:

Waste excluded under §261.4 or exempt from regulation as a hazardous waste

Specify exclusion or exemption by regulatory citation and describe:

Is the waste a listed hazardous waste? :
F-listed per §261.31
K-listed per §261.32
P-listed per §261.33(e)
U-listed per §261.33(f)

Is the waste a characteristic hazardous waste?:
Ignitable (D001) per §261.21
Corrosive (D002) per §261.22
Reactive (D003) per §261.23
Toxic (D004 - D043) per §261.24

PCB-contaminated waste

Verify RCRA status at §261.8 (TSCA regulations may apply):

RCRA Waste Determination:

If hazardous, list waste codes:

RCRA Exempt

If RCRA Exempt, explain:

Waste Storage, Treatment, and Disposal

Specific description of waste management from generation point to final disposition:

Approximate waste generation rate:

Are Land Disposal Restrictions (LDR) applicable?:

UHC's present above treatment standards. [Only applicable to certain characteristically hazardous waste codes specified by regulation.]

Specify UHC's:

DOT Shipping Name:

Additional Information

IMPORTANT: Attach all supporting documentation (e.g., SDS's, laboratory analysis, generator knowledge, etc.) to this waste stream determination (pdf):

Additional Comments:

Form Completed By
* Full Name:

* Email: