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800.900.3366 / 323.269.9876
Southwest Processors, Inc.
4120 Bandini Boulevard
Vernon, CA 90058
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ACCEPTED WASTE
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Pre Qualification Questionnaire
Transporter Name
*
If you are a Broker put your company name here. This is the person that will be invoiced for the material.
Transport Company Phone Number
*
Transport Company Email
*
1. Generator Information
Company Name
*
This is the Generator of the waste.
Contact Name
*
First
Last
Contact Phone
*
Contact Email
*
EPA Number (if applicable):
SIC (standard industrial classification)
Permit Number (Industrial wastewater discharge)
Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Responsible Party Information
If a third party is representing the generator such as a consultant or you are the person filling out the Pre-Qual for someone else at the generator location, your information goes here.
Name / Title
Contact Phone
Description of general activities conducted at generator’s facility
*
Southwest Processors, Inc. may not require laboratory analysis of wastes that are certified to contain no regulated metals, cyanide, toxic organic compounds, sulfides or chlorinated hydrocarbons.
Generators and Waste Haulers Please Note:
We Cannot accept waste water until the physical characteristics and waste water information has been reviewed and accepted. Please complete the separate physical characteristics and waste description for each waste water interceptor locator at this facility.
PHYSICAL DESCRIPTION AND WASTE WATER INFORMATION SHEET
2. Generator's Process Information
GENERATOR’S PROCESS INFORMATION
*
Detailed description of specific activity which created the waste contained in this interceptor.
Samples being submitted were taken from (location and ID number)
Check one:
*
Clarifier
Trap
Holding Tank
Other (please describe below)
Other (describe)
3. Physical Characteristics and Description of Waste
Select One
*
Liquid
Mud
Sludge
Slurry
Other (please describe below)
Other (describe)
Water Concentration %
*
Mud Concentration %
Other Concentration %
Other Concentration %
Other Concentration %
Waste Properties
pH (Select One)
*
0-2
2-4
4-6
6-8
8-10
10-12
12-14
Odor (Select One)
*
None
Low
Medium
High
Color (Select One)
*
Clear
Light
Dark
Black
Explosive
*
YES
NO
Don't Know
Reactive
*
YES
NO
Don't Know
Pyrophoric
*
YES
NO
Don't Know
4. Component Listing
Does the waste contain (or could contain) ANY of the following
Arsenic
*
Yes
No
Maybe
Approx (mg./l)
Cadmium
*
Yes
No
Maybe
Approx (mg./l)
Chromium
*
Yes
No
Maybe
Approx (mg./l)
Copper
*
Yes
No
Maybe
Approx (mg./l)
Lead
*
Yes
No
Maybe
Approx (mg./l)
Mercury
*
Yes
No
Maybe
Approx (mg./l)
Nickel
*
Yes
No
Maybe
Approx (mg./l)
Silver
*
Yes
No
Maybe
Approx (mg./l)
Zinc
*
Yes
No
Maybe
Approx (mg./l)
Cyanide
*
Yes
No
Maybe
Approx (mg./l)
Does the waste contain (or could it contain) any measurable amount of total identifiable CHLORINATED HYDROCARBONS?
*
Yes
No
Constituent / Concentration (mg./l)
If yes, please list the source and approximate concentrations
Does the waste contain (or could it contain) any known or suspected TOXIC ORGANIC COMPOUNDS? (Examples: Benzene, Toluene, etc.)?
*
Yes
No
Constituent / Concentration (mg./l)
If yes, please list the source and approximate concentrations
Could the waste contain SULFIDES in excess of 0.1 mg/l?
*
Yes
No
Constituent / Concentration (mg./l)
If yes, please list the source and approximate concentrations
Please up-load any additional information regarding this waste stream.
Max. file size: 100 MB.
This includes any analytical or MSDS information that is available. If you click "Save and Continue Later" this file will be lost. You can always email us a copy of the analytical after the submittal of the Pre-Qual.
CERTIFICATION
I certify that the information I have provided in response to the questionnaire contained in the PRE-QUALIFICATION QUESTIONNAIRE are true, correct and complete to the best of my knowledge. I understand that after reviewing the information you have provided, Southwest Processors, Inc. may require a sample of the waste unidentified in the questionnaire be submitted for analysis prior to acceptance of the waste for treatment.
Name / Title
*
Email
*
Date
*
MM slash DD slash YYYY
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