Attachment 9: DLA Form 2511 HWPS

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HAZARDOUS WASTE PROFILE SHEET

Prescribed by: DOD 4160.21-M
Sponsor: Disposition Services

NOTE: Explosives, Shock Sensitive, Pyrophic, Radioactive, and Etiological Waste are not normally accepted by the DLA Disposition Services Site. Contact your DLA Disposition Services Site for further guidance if your waste meets any of these categories.

PART I

A. GENERAL INFORMATION

1. GENERATOR'S NAME:

WASTE PROFILE NO.:

3. ZIP CODE

2. FACILITY ADDRESS:

6. TECHNICAL CONTACT:

4. GENERATOR USEPA ID:

7. TITLE:

B. WASTE INFORMATION

5. GENERATOR STATE ID:

8. PHONE:

1. NAME OF WASTE:

2B. DEMIL CODE:

2A. US EPA WASTE CODE:

A

B

C

D

F

G

P

Q

E

2C. STATE/LOCAL/HOST-NATION WASTE CODES:

3. PROCESS GENERATING WASTE:

4. PROJECTED ANNUAL VOL.:

5. MODE OF COLLECTION:

6. IS THIS WASTE A DIOXIN LISTED WASTE AS DEFINED IN 40 CFR 261.31?

YES

7. IS THIS WASTE RESTRICTED FROM LAND DISPOSAL? (40 CFR 268)

NO
YES

NO

HAS AN EXEMPTION BEEN GRANTED?

YES

NO

DOES THE WASTE MEET APPLICABLE TREATMENT STANDARDS ALREADY?

(If Yes, Enter Reference Standards in Part II, Block 6)

YES

NO

PART II

1. MATERIAL CHARACTERIZATION (Optional - Unless otherwise indicated)

COLOR:

DENSITY:

TOTAL SOLIDS:

PHYSICAL STATE

(Mandatory)

BTU/LB:

ASH CONTENT

Solid

Liquid

Semi-Solid

2. RCRA CHARACTERISTICS (Check all that apply)

Gas

IGNITABLE (D001)

WATER REACTIVE

CYANIDE REACTIVE

HIGH TOC (> 10%)

LOW TOC (< 10%)

TOXICITY CHARACTERISTIC (D004-D043)

LAYERING

SULFIDE REACTIVE

Multilayered

Bilayered

Single Phase

Other

CORROSIVE (D002)

REACTIVE (D003)

FLASH POINT:

TREATMENT GROUP:

PH:

WASTEWATER

NON-WASTEWATER

CORRODES STEEL

3. CHEMICAL/MATERIAL COMPOSITION (List all components and contaminants, including PCB's and any applicable F-Listed and Underlying Hazardous Constituents)

COMPONENT

CAS#
Be as descriptive as possible. Chemical names or generic descriptions, e.g. 'sludge',

CONCENTRATION

RANGE

paint solids, 'water', etc. are acceptable.

DLA FORM 2511, NOV 2016

(Formerly DRMS Form 1930)

PDF (DLA)

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HAZARDOUS WASTE PROFILE SHEET (Continued)

Prescribed by: DOD 4160.21-M
Sponsor: Disposition Services

3. MATERIAL COMPOSITION/UNDERLYING HAZARDOUS CONSTITUENTS

CAS#

COMPONENT

Be as descriptive as possible. Chemical names or generic descriptions, e.g. 'sludge', paint solids, 'water', etc. are acceptable.

CONCENTRATION

RANGE

RANGE TOTAL MUST EQUAL AT LEAST 100%

4. SHIPPING INFORMATION:

YES

DOT HAZARDOUS MATERIAL?

NO

(If "NO" skip to block 5)

PROPER SHIPPING NAME:

HAZARD CLASS:

U.N. OR N.A. NO.:

PACKING GROUP:

ADDITIONAL DESCRIPTION:

METHOD OF SHIPMENT

BULK

DOT REPORTABLE QTY (RQ)