PRASANNA PRE PROCESSING PRIVATE LIMITED

(HUMNABAD -BIDAR)
HAZARDOUS WASTE SAMPLE DETAILS
Please provide details when submitting waste sample for analysis.
(DO NOT LEAVE BLANK SPACES)

Name of the Generator Member Ship No:

Factory Address

Ph.No.
E-mail
Contact Person (Technical) Designation
Ph.No. E-mail

Description of Waste (Sample)

(Like ETP1o/ ETP2o/ Spent Carbon etc.)
Waste Generating Process/ System
Hazardous waste category No.
(As per Haz. Waste Mgt. Handling rules-2016)
Sample collected from (location)
(ex. Drum, Lagoon, Pond, Tank, Vat, etc.)
Is waste multi layered Yes/No (if yes specify details) Sample Collected by

Sampling Methodology Date of Sampling

Rate of Waste generation Current accumulation

Waste Physical Characters

Waste chemical composition Metals
Mark if Present Cyanide/ Sulfide/ Azide/Amide/ Nitrate Explosive / Flammable / Corrosive / Oxidizing / Reducing

Violent reaction with Solvents

Chemical Component (must total 100%) Average % Chemical Component (must total 100%) Average %

Special handling instructions

Raw Materials used in process (Please provide Material Safety Data Sheets)
1 6
2 7
3 8
4 9
5 10

Name of the person

Signature of the person Seal of the Generator

Note: A new process begins or a change in an existing process occurs the waste has to be re analyzed