Recertification Profile Form

Recertification Form

"*" indicates required fields

In accordance with PTI’s RCRA Part B permit Waste Analysis Plan requirements, all waste profiles must be resubmitted for review and approval on an annual basis. If any information on the previously approved profile has changed, a new Hazardous Waste Profile application must be submitted for review and approval.

There can be no changes to the previously approved profile including the waste stream description; please complete the certification below:

Generator*

Generator EPA ID Number

PTI Waste Profile #

Waste Stream Description

PFAS Screening

The Los Angeles County Sanitation District (LACSD) now requires Phibro-Tech, Inc to screen all waste streams (new and reoccurring) for PFAS (Perfluoroalkyl and polyfluoroalkyl substances) as described below. LACSD will need to approve any profiles with PFAS results > 100 nanograms/liter.

Any amount of aqueous film forming foam (AFFF) such as fire-fighting water, fixed fire extinguishing system test water, and/or contaminated groundwater.
Process, rinse, and/or waste solutions containing hexavalent chromium (chrome VI or Cr(VI)) from chrome plating operations.
Any other waste streams that are known or suspected to contain excessive quantities of PFAS.

Does this waste fall into one of the above 3 categories?

Does this waste fall into one of the above 3 categories?

Yes

By typing my name below, I, the generator OR authorized agent on behalf of the generator, certify that: The above listed waste profile remains the same as previously approved and that there are no changes in EPA waste codes, state waste codes, processes or operations generating this waste, and that there are no changes in physical and chemical properties of the waste material as profiled previously or the status of this waste pursuant to any Land Ban promulgated in 40 CFR Part 268.

Authorized Name*

Title*

Date*

Year

Month

Day

Email*

NOTE: A representative sample is still required as part of this recertification.

Corporate Office: Glenpointe Center East, 3rd Fl, 300 Frank W. Burr Blvd Ste 21, Teaneck, NJ 07666-6712 · (201) 329-7300

SEND SAMPLES TO: Phibro-Tech, Inc. 8851 Dice Road Santa Fe Springs, California 90670 · (800) 777-1850

Recertification Form

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