Company Name:

Street Address:

Mailing Address (if different from Street Address)

Town / City:                    Province:   BC Alberta NWT Yukon Ontario Quebec Sask. PEI NS NFLD NB

Email Address:

Phone No:        Fax No:  <example>  6041231234

Contact Person:             Title:  Mr Mrs Ms Miss Mgr. Chief Owner Assistant Supervisor

Consultant/Contractor:

Hauler:

Description of Waste Type, Volume and Nature

1 )    Waste Type/Common Name:

2)    Estimated Volume (m3):

3)    Estimated Weight (tonne):

4)    Describe Shipment Container:

5)    State Handling Instructions:

6)    State Origin and History of waste *

7)   Describe all tests performed on the waste and rationale used to choose test methods:

* If wastes are derived from more than one generator, list each generator, waste type and volume by generator: 

8)   Describe the number of samples collected for analysis, the sampling method(s) and 
rationale used to support the representativeness of the samples:

9)    General Waste Characteristics (applicable to the most industrial and oilfield wastes):

        a)  Colour:                     

        b)  Physical State *   Dust/Powder Solid (dry) Sludge Semi-Solid                             

        c)  Odour     No Yes    
             If yes, Describe strength and nature:

        d)  Sulphur Content (% by weight):     

        e)  Hydrocarbon Content (% by weight):

        f)  Flashpoint:     

        g)  pH (1:1 ratio with distilled water for solids):

        h)  Density g/cm3:   

        i)  Chloride Concentration: 

        j)  SAR Value:        

       k)  Electrical Conductivity:

        l)  Other relevant notes:   

10)        Is the waste radioactive (greater then 74 Bq/kg)?   No Yes

11)        Are PCBs expected to be present?     No Yes

12)        Is the waste a Special Waste in accordance with the Special Waste Regulation under the BC Waste management Act?  No Yes

13)        Are heavy metals, pesticides and/or halogenated organics, cyanides or other regulated parameters expected to be present?  No Yes

If Yes:  provide concentrations for all listed or regulated parameters reported from the analysis of waste treatment:   

                       PARAMETER                      UNITS                       CONCENTRATION                           

Wright Special Waste Treatment Facility

Application for Treatment of Waste

Waiver Form

    On behalf of , I hereby declare that I am familiar with  being the material to be treated, and that it meets all  of the Acts and regulations concerning transportation and treatment.

        I further confirm that the samples of the material and the testing results supplied to you are a representative of all material to be disposed.  If upon further testing by the landfarm operator or the waste generator, the material is found to be unacceptable for treatment (or if deemed by the operator to be substantially different than initially described), I accept all responsibility for the operators testing costs and for the removal and dispersal of the unacceptable materials, including hourly charges for landfarm staff.

Company Representative      

 Title 

Email Address: 

Witness

Name:  Phone No:  <example>  6041231234

Witness Email Address :

PROJECT\EE25000\102-152\ee25102\BCEnv\Ops_Plan1.doc
Plan version: Issue 1, Rev 1
Permit amendment date: 25 March1999                                                                                                                 

Plan Date: July 1999