Waste Contractor Audit Form

HSE Management System Document HSE Form
Mandatory Solution 103_4 FOR_Waste Contractor Audit Form_v1.0 (M)
Hazardous Waste Contractor Audit Form
Table of Contents
1. General Information (shaded area for Syngenta use only).......................................................................2

2. Environmental Setting............................................................................................................................... 4
3. Financial Information................................................................................................................................ 5
4. Regulatory Information............................................................................................................................. 6
5. Technical Information............................................................................................................................... 7
6. Personnel Training.................................................................................................................................. 10
7. General Facility Standards...................................................................................................................... 11
8. Waste Acceptance – Manifest System, Record Keeping and Reporting................................................14
9. Storage/Transfer Station......................................................................................................................... 15
10. Landfill and Impoundment Checklist................................................................................................... 19
11. Groundwater Monitoring Checklist...................................................................................................... 23
12. Thermal Treatment/Incinerator Checklist............................................................................................24
13. Effluent Treatment Checklist............................................................................................................... 28
14. Recycling, Treatment Facilities Checklist............................................................................................30
15. Additional Information to be Provided................................................................................................. 32
Classification: INTERNAL USE ONLY page 1 of 35

Scope of Form: Audit Questionnaire for Waste Management Facilities
1. General Information (shaded area for Syngenta use only)

Date of audit:
Audit leader:
Audit team:
Name: Title:
Facility Information
Facility name:
Facility address:
Mailing address:
Coordinates:
Site Contact: Name & Title:

Telephone:
Mobile:
Email:
Permit Holder (if as above, please indicate)

Firm name:
Address:
Contact person: Name: & Title

Telephone:
Mobile:
Email:
Operator (if as above, please indicate)

Name:
Address:

Telephone:
Mobile:
Email:

Property Owner (if as above, please indicate)

Name:
Address:

Telephone:
Mobile:
Email:
Environmental/ Engineering Consultants (advised on design and construction, environmental

monitoring, etc.)
Company Name:
Address:

Telephone:
Mobile:
Email:
Details
Syngenta’s Use of this Facility (shaded area for Syngenta use only)
Syngenta operations using the facility and the materials handled by each operation:
Contacts:

2. Environmental Setting
2.1. Zoning, e.g. industrial, residential, etc.
2.2. What immediately surrounds the facility? North:

South:
East:
West:
2.3. Distance (in kms) and direction to:
Residential and Schools or Day Care facilities:
Waterways:
Public Facilities:
Wetlands or Flood Plain:
Drinking Water Wells:
Other (please specify):

2.4. Are there any on-site groundwater wells? Is the water used for drinking purposes?
2.5. Is the area prone to natural disasters, e.g. flooding, typhoons, earthquakes, etc.?
2.6. Provide a brief history of the site use and ownership.
2.7. Provide a description of past activities that may have caused environmental impairment (impacts).
2.8. Have any environmental soil and groundwater investigations been completed or has an
Environmental Impact Assessment been conducted of the site?

3. Financial Information.
The purpose of this section is to assess whether the financial resources and the insurance are sufficient to
protect Syngenta in case of problems at the site.
3.1. Affiliated companies and/or other locations:

3.2. Employment:
3.3. Land area:
3.4. Number of years in operation:
3.5.Please detail the Last Year -1 Last Year % Change
following financial
information:
Current assets
Non-current assets
Current liabilities
Non-current liabilities
Total liabilities
Retained earnings
Current year retained earnings
Revenue
Net Income
3.6.What is the debt to equity
ratio?
3.7.What is the total liabilities
/ owner’s equity ratio?
3.8.What is the current
assets / current liabilities
ratio?
3.9.Name of insurer:
Note: a copy of the certificate of insurance must be attached

3.10. Type of policy:
3.11. Amount of coverage:
3.12. Deductible, if any:
3.13. Provide details on the basis of coverage. Have any claims been made? Occurrence?
Does it cover closure/post closure? Yes No
If not, explain:
3.14. Does the firm have sufficient financial resources to ensure that it will be a viable company in
the waste disposal market?


4. Regulatory Information.
The purpose of this section is to assess whether the facility has the necessary authorization and how the
facility is perceived by the community.
4.1. Does the firm have all the necessary permits? Are there any limitations which restrict the type or
quantity of waste that can be handled? Is Syngenta waste able to be handled under current
authorisation? Please provide list and attach a copy of the permits.
4.2. Provide details of any problems, notices, fines, complaints, etc., including noise, dust, odour:
Citizen/neighbours complaints:
Regulatory complaints/notices/fines/suspension of permit
Environmental problems caused by facility that are being addressed:
4.3. Has the facility been inspected by regulatory agencies? Give dates and summarize findings.
4.4. List the regulatory authorities that have jurisdiction over facility:

5. Technical Information.
The objective of this section is to understand the operations and condition of the facility to determine if there
are significant risks handling Syngenta’s wastes at the facility.
5.1. Current operations: Yes No Capacity (tons/day)
Hazardous waste / Secure landfill1
Non-hazardous waste landfill1
Incinerator(s)
Deep well injection
Disposal pit/lagoon
Solvent recovery
Liquid waste treatment
Stabilisation
Waste blending
Drum washing
Drum storage
Tank storage
Transportation

1
One or more liners with leachate collection
Total volume handled per month:

5.2. Briefly describe each applicable operation

5.3. Type of material handled: Liquid Solid Semi-solid
Drums Bulk Drums Bulk Drums Bulk

Chlorinated solvents
Non-chlorinated solvents
Oils
Organic acids
Pesticides
PCBs
Radioactive material
Explosives
Water reactive
Inorganic
Acids
Bases
Metals
Laboratory waste
Biological/medical waste
5.4. Are wastes or residues remaining after blending or treatment that needs to be transported to other
locations? If yes, please provide details below.

5.5. Environmental monitoring:
Are the following areas routinely monitored? Yes No
Groundwater
Emission stacks
Container disposal
Process wastewater
Residue (e.g. ash, sludge) composition

5.6. Transportation (if the facility provides transportation services to the site, specify the type and
amount of equipment that is owned and leased at any time):
Equipment:
Tank truck:
Vacuum truck:
Flatbed trailer:
Enclosed trailer:

6. Personnel Training.
The purpose of this section is to understand whether there is a formal training program.
6.1. Describe the type of training given to new employees, administrative staff, operators, etc.? Is
training internal on-the-job, external, etc.?
- HSE Induction
-
6.2. Is there documentation of the HSE and operational training Yes No

conducted, e.g. records, certificates, etc.?
- Sertifikat Training dari pemerintah
- Dokumentasi Training
6.3. Are site personnel aware of the hazards and safe work procedures when handling hazardous
waste?

7. General Facility Standards.

The purpose of this section is to understand whether the facility has appropriate procedures to handle
spills, releases and problems.
7.1. General manager/senior operator on-site:
Name & Title:
Education:
Experience
(years):
7.2. Security:
a. What security measures are taken to prevent unauthorised access to the facility, e.g. 24 hour
surveillance system, security guards, fence etc.?
7.3. Audits and certificates:

a. Does the facility have any certifications, e.g. ISO 14001, ISO 9001?
Laporan audit ISO IMS
b. Does the facility have a written internal audit program? Yes ✘ No
Does it include:
i. Monitoring equipment? Yes ✘ No
ii. Safety and emergency equipment? Yes ✘ No
iii. Operating equipment? Yes ✘ No
iv. Types of equipment problems:
Malfunctions? Yes No
Operator error? Yes No
Discharges? Yes No
c. How frequently are audits conducted? 1 tahun sekali
d. Does the plant maintain an inspection log? Yes No
Provide any additional comments

7.4. Emergency preparedness and prevention:

a. Does the facility handle ignitable or reactive wastes? Yes ✘ No
If yes, is waste separated from sources of ignition or reaction (open flames,

smoking, cutting and welding, hot surfaces, frictional heat), sparks (static,
Yes ✘ No
electrical or mechanical, spontaneous ignition (e.g. from heat producing
chemical reactions) and radiant heat?
If no, explain.
b. What are the main potential emergencies, including transportation?
Kebakaran, Tumpahan, Gempa Bumi
c. Is the facility equipped with internal communication or alarm system? Yes ✘ No
Describe the system in place.
Is it accessible in case of an emergency? Yes ✘ No

d. Is the facility equipped with an adequate supply of firefighting water or fire
suppression chemicals? Yes ✘ No
Describe the system in place: Hydrant total 9, APAR Powder tiap Gudang ada 3, APAB ada 2 pcs, APAR
CO2 ada 2 pcs, Alarm sedang dipasang
e. Is the facility equipped with an adequate emergency response plan? Yes ✘ No

SOP Gawat darurat
If yes, provide comment.
f. Does the facility have a plan to prevent, contain and respond to spill or Yes ✘ No
release of waste or oil?
Spill kit dan bak penampung
If yes, provide comment.
g. Are spill kits provided in appropriate areas? Yes ✘ No

h. Have operators/site personnel received emergency training? Yes ✘ No
Laporan training gawat darurat tahun lalu
i. Are drills conducted? Yes ✘ No
Tahun lalu
If yes, provide details.


j. If there was an emergency situation, what contingencies does the facility have?
7.5. Health and safety:

a. How does the facility ensure employee exposure to hazards is understood and minimised?
Penjelasan HIRAC
b. What personal protective equipment is provided to employees?
Daftar APD
c. Have there been cases of work related illnesses or incidents at the site? Yes No ✘
If yes, provide details below
d. Are first-aid kits easily accessible to employees at any time? Yes ✘ No

e. What welfare and shower facilities are provided for site personnel?
Tempat mandi tersedia
7.6. Closure cost estimates:

Has estimate been made for the cost to close the facility when operations are Yes No
stopped?
If yes, what is the estimated cost?

8. Waste Acceptance – Manifest System, Record Keeping and Reporting

The purpose of this section is to understand what systems are in place to manage waste and whether the
facility has a record of wastes that were handled at the site.
8.1.Acceptance criteria:
a. Is there a waste acceptance criteria and/or checklist? Yes No
Ada, sesuai dengan Code Limbah (Marketing & QC)
If yes, provide brief description.
b. Does the facility sample and characterise the waste entering the facility? Yes ✘ No
Laporan sampling tim QC
If yes, describe the analytical facilities available and testing conducted on the waste.
8.2.General information:
c. Is there a system in place to document waste received by the facility? Yes ✘ No
- Dokumen limbah masuk
- Dokumentasi pemusnahan
d. Does the facility retain copies of all manifests or waste shipping records? Yes ✘ No
- SIMPEL
e. Are the manifests signed and dated and returned to the transporter/ Yes No
generator?
f. Has the facility treated any waste not accompanied by a manifest? Yes No
g. h. Does the facility have a written operating record? Yes ✘ No

SOP tertulis .. yes
If yes, does the system or record include description and quantity of each waste received, the name of the
generator, and the methods and dates of its treatment, storage or disposal at the facility?
i. j. If residue or waste is generated after treatment is sent to an off-site facility, Yes ✘ No

is there a system in place or record to document this?
Laporan limbah ke pihak ke 3 (ke WGI, ke PPLI
If yes, does the system or record include description and quantity of each waste received, the name of the
generator, and the methods and dates of its treatment, storage or disposal at the facility?

8.3.
8.4.Quantitative gauge – how does the facility measure the quantity of waste, e.g. weighbridge,
estimate, etc.?
8.5.
8.6.Treatment – how does the facility segregate and separate the waste material received?

9. Storage/Transfer Station
Applicable: Yes No
9.1.Type(s) of storage facilities:
Container - drums Tanks:
Container - IBCs Aboveground
Other (please specify): Underground

9.2.Describe all types of waste handled at the facility
9.3.Describe all waste handling and transfer operations performed at site
9.4.Container storage
a. Provide a description of the container (drum/IBC) storage area, e.g. construction material, capacity,
stack height, stored in/out of dedicated area, general housekeeping, etc.?
b. General information:
Is there an inventory of waste stored? Yes ✘ No
Are there signs and labels, e.g. requirements for PPE, waste type, etc.? Yes ✘ No
Is access controlled? Yes ✘ No
Is emergency response equipment/controls provided, e.g. fire extinguishers, spill Yes ✘ No

kits, emergency shower and eyewash, etc.?

c. Number of containers:
Permitted:
Currently stored:
d. Are all containers:
In good condition? Yes No
Securely closed? Yes No
Segregated by waste (chemical compatibility) type? Yes No
If no, how is the waste segregated?

Gudang dipisahkan berdasarkan karakteristik
Are all containers labeled? Yes ✘ No

e. Is there a containment system for spill, leaks and precipitation? Yes ✘ No
If yes, is the containment system:
Designed to efficiently drain and remove liquids? Yes ✘ No
Of sufficient capacity to contain 110% of the volume of the largest container or Yes No ✘
25% of the aggregate volume stored?
Is the base underlying the containers free of cracks or gaps Yes No ✘

and impervious to the materials being stored?
If no, provide detail.
f. Is storm water prevented from entering the containment system? Yes No ✘
g. Is accumulated rainwater or spills removed from the sump or collection Yes No ✘

area in a timely manner?
If no, provide detail.
If yes, how is the wastewater disposed?

Tank
9.5.Tank storage
a. What are the number and size of each tank?
b. What are the unloading/loading procedures for the tanks?
Provide details, including spill protection controls.

c. General information:
Is there an inventory of waste stored? Yes No
Are signs and labels evident, e.g. requirements for PPE, waste type, etc.? Yes ✘ No
Is emergency response equipment/controls provided, e.g. fire extinguishers, Yes ✘ No

spill kits, emergency shower and eyewash, etc.?
d. Do tanks have controls to prevent overfilling? Yes No
e. Do aboveground tanks have a containment system for spills, leaks and Yes No
precipitation?
If yes, is the containment system:
Designed to efficiently drain and remove liquids? Yes No
Of sufficient capacity to contain 110% of the volume of the largest container or Yes No
25% of the aggregate volume stored?
Is the base underlying the containers free of cracks or gaps Yes No

and impervious to the materials being stored?
f. Is storm water prevented from entering the containment system? Yes No
g. Is accumulated rainwater or spills removed from the sump or collection area Yes ✘ No
in a timely manner?
If no, provide details.
If yes, how is the wastewater disposed?

Close system
h. Are there underground tanks? Yes ✘ No
If yes, what is the tank capacity and material stored?
i. Are the underground tanks subjected to periodic integrity testing? Yes No
If yes, please explain frequency and method.

j. Have any underground tanks been found to be leaking? Yes No ✘
What method of leak testing or leak detection is used?
If yes, please explain frequency and method.
9.6.
9.7.Are storage areas inspected, i.e. corrosion, leaks, spills, etc.? Yes ✘ No
If yes, please explain frequency, by whom and method.
9.8.
9.9.Evidence of leaks in storage area? Yes No
9.10.
9.11.Under what arrangement is waste transported to site?
Milk run (i.e. transporter picks up from multiple facilities on same trip)
Dedicated shipment
Other (please describe)
9.12.
9.13.Who transports waste from staging or checking area to storage facilities or treatment/disposal
facilities?
Please provide details.

10. Landfill and Impoundment Checklist.

The purpose of this section is to understand the design of the landfill. Applicable: Yes No ✘
10.1. Construction and Design Information:

a. Does the landfill conform to a design standard, e.g. USEPA? Yes No
If yes, indicate the standard.
b. Does the landfill have two or more liners and a leachate detection system Yes No
between the liners?
c. Area of landfill (m2):
What is the area (m2) currently closed?
d. Total estimated disposal rate/year:
e. Estimated permitted facility life remaining:
f. Are side walls and bottom constructed with impervious materials? Yes No
Describe depth/width and permeability of material:
g. Is bottom material compacted? Yes No

h. Does unit contain synthetic liner(s) on bottom and sides? Yes No
Describe type of liner(s) and thickness:
i. What is the elevation of the uppermost groundwater at the unit(s) area?
Are there any portions of the unit(s) bottom below or closer than 3 m to the
Yes No
uppermost groundwater?
What is the depth of the unit bottom below grade?

10.2. Leachate collection and treatment:
a. Does each cell/sub cell contain a leachate collection system? Yes No
Describe the system:
b. Is system controlled? Manually Automatically

c. What is the annual quantity of leachate water collected (in m3)?
d. Is there a second leachate drainage system constructed under the base Yes No
liner?

e. Are the leachate collection system pipes rinsed every two years? Yes No
f. Are the leachate collection system pipes inspected by a camera at least Yes No
every 2 years?
g. Describe how the leachate is managed/treated, e.g. is it treated on-site, how is it treated, where is it
discharged to, etc.?
h. Is a wastewater treatment permit required? Yes No
If yes, what are the discharge requirements versus operating data?
i. Does the leachate collection piping system Yes No Not necessary

include an automated gas warning protection
system?
j. Are automated gas warning protection systems Yes No Not necessary
installed in the leachate collection sumps
k. Can leachate be collected in a lagoon or storage Yes No Not necessary
tanks?
If yes, what is the retention system capable of storing? Rainwater Leachate wastewater
What is the capacity of the retention system (in m3)?
Is the retention system fitted with an automated high level alarm protection Yes No
system?
l. Is there a leachate collection sump? Yes No
If yes, describe the collection sump system, including design, access, etc.
10.3. Operations:
a. Describe measures to prevent commingling of incompatible wastes?
b. Is the landfill managed so as to control wind dispersal? Yes No

c. Is the landfill cell segregated in sub cells? Yes No
If yes, please describe:
d. Is a 3D grid system employed for waste placement in landfill cells? Yes No

e. Are covers used at the site? Yes No
If yes, describe the cover procedures, including interim systems of cover:
Describe the material(s) and source of cover:
f. Is pretreatment of waste prior to disposal performed? Yes No
If yes, please describe:
g. Are containers holding liquid wastes (or wastes containing free liquids) Yes No
placed in the landfill?
h. Are there controls to prevent storm water flow onto the active portion of the Yes No
landfill?
i. Is runoff collected and controlled? Yes No
j. If yes, are collection and holding facilities emptied after a storm event? Yes No
k. Is the landfill managed so that wind dispersal is controlled? Yes No
l. Are landfills inspected weekly and after storms for defects? Yes No
m. Does owner/operator retain records at the facility? Yes No
If yes, are the following maintained:

On a map, exact location and dimensions, including depths of each cell? Yes No
Contents of each cell and approximate location of each hazardous waste Yes No
type within the cell?
n. Gas handling system:
Are waste gas emissions generated? Yes No
Are the waste gas emissions collected and managed? Yes No
If yes, describe how are the gases managed?
Are there waste gas detection systems? Yes No
Is there an automated alarm protection system? Yes No

o. Signage:
Are ‘’No Unauthorised Dumping’’ warning signs (or equivalent) posted at the Yes No
site?
Are ‘’Prohibited Waste’’ warning signs (or equivalent) posted at the site? Yes No

10.4. Closure of landfill:

a. Is a closure plan kept on site? Yes No
If yes, does the final cover plan provide for the following:
Minimise migration of liquids? Yes No
Maintenance? Yes No
Promote drainage, minimise erosion? Yes No
Accommodate settling and subsidence? Yes No
Cover less permeable than bottom liner or does it include natural subsoil? Yes No
b. After final closure, does owner/operator provide the following:
Maintenance of final cover? Yes No
Continue to operate leachate collection and removal system until leachate is no Yes No
longer collected?
Maintain groundwater monitoring? Yes No
Prevent storm water run-on/off from eroding and damaging cover? Yes No
Protect and maintain surveyed bench marks? Yes No

10.5. If waste is managed in an impoundment, please provide details below, i.e. waste not stored in a
landfill.

11. Groundwater Monitoring Checklist.

The purpose of this section is to determine if there is a plan to assess Applicable: Yes No
groundwater contamination.
11.1. Monitoring System

a. Does the facility have a groundwater monitoring system in operation? Yes No
If yes, does the system consist of:
At least one upgradient monitoring well? Yes No
At least three downgradient monitoring wells? Yes No

11.2. Sampling and Analysis
a. Does the facility obtain and analyse samples from the groundwater monitoring Yes No
system?
b. c. Has the facility developed and followed a groundwater sampling and analysis plan? Yes No
If yes, does this plan include procedures and techniques for:
Sample collection? Yes No
Sample preservation? Yes No
Analytical procedure/methods? Yes No
Chain-of-custody control/QA/QC standards? Yes No

d. e. Does the facility determine the concentration of the following parameters regarding groundwater samples?
Parameters characterising the suitability of the groundwater as a drinking water Yes No

supply as specified?
Parameters establishing groundwater quality (chloride, iron, manganese, phenols, Yes No

sodium, sulphate)?
Parameters used as indicators of groundwater contamination (pH, specific Yes No

conductance, total organic carbon, total organic halogen)?
f. g. Has the owner/operator established initial background concentrations or values of Yes No
all parameters specified above at least on a quarterly basis?
h. i. Has the owner/operator obtained at least four replicate measurements for each Yes No
sample, and determined the initial background arithmetic mean and variance?
11.3.
11.4. Preparation, evaluation and response
a. b. Has the owner/operator assessed the impact of the facility on groundwater quality? Yes No
If yes, what does the evaluation indicate?

c. d. For each well, has owner/operator compared the results with initial background Yes No
mean?
e. f. Do the comparisons for down gradient wells show a significant increase (or pH Yes No
decrease) in constituent levels?

12. Thermal Treatment/Incinerator Checklist

Applicable: Yes No
12.1. Type of facility:
Asphalt Plant Waste Incinerator Soil Treatment
Cement Kiln Brick Manufacturer Other (please specify):
Furnace Design Information

12.2. Type of waste facility is permitted to treat:
12.3. Furnace design information:

a. Type of and number of Furnaces:
Rotary Kiln ✘ No: Multiple Hearth No:
Fluid Bed No: Other (please specify):

b. Furnace design conditions:
Furnace 1 Furnace 2 Furnace 3
Heat release (specify units):
Feed rate (#/hr):
Operating temperature (C):
Operating pressure (specify units):
Fuel source:
Year constructed:
Continuous Semi-continuous Batch operation

c. Furnace feed system(s):
Conveyor Ram Injection Shredder Auger Other (specify):

d.Does the facility’s operation include recovery of energy resulting from its treatment process?
Yes No
If yes, is there documentation to demonstrate the facility’s energy recovery effectiveness?
Yes No

e.Air emission control equipment – major components?
Baghouse Cyclone Gas Quenching
ESP Direct Heat Impinger Heat Exchanger
Scrubber Specify type:
Neutralization Specify type:
Special features:
f.When was the air emission control equipment installed?
g.Sketch incinerator and control system (show all major components and processes controlled, especially air
emissions control system). Alternatively, include facility-provided diagram if applicable.
h. Operating schedule:
Hours/day: Days/week:
i. Scheduled maintenance periods:
j. % scheduled and unscheduled downtimes:
% Operating availability (% of 8,760 % Service factor (% of scheduled downtime vs

hours/year) total downtime)
k. Control alarm systems – describe those conditions that result in automatic feed cutoff:
12.4. Test burns and/or stack tests

a. Is the test burn or stack test complete? Yes No
b. Did the facility pass the test? Yes No
c. Date of most recent burn or stack tests?
d. Minimum Destruction and Removal Efficiency (DRE) during test burn?
e. Minimum PCB or FO2O series DRE?
f. Minimum HCI removal?
g. Particulate emissions rate?
h. Minimum Combustion Efficiency (CE) during test burn?
i. Residence time (in secs)?
j. Temperature (C)?
k. Other comments:

12.5. Operating data:

Temperature Residence Time
Primary Furnace
Gas incinerator (after burner)
Ambient monitoring: Frequency Type of Monitoring
Total suspended particulates (TSP)
Sulphur dioxide (SO2)
Oxides of nitrogen (NOx)
Pressure
Residence time
Other (specify):
Emissions monitoring: Frequency Type of Monitoring

Particulates (specify type)
Opacity
Sulphur dioxide (SO2)
Carbon dioxide (CO2)
Carbon monoxide (CO)
Oxides of nitrogen (NOx)
Hydrochloric acid (HCl)
Polychlorinated biphenyls (PCBs)
Volatile organic compounds (VOC)
Oxygen (O2)
Mercury (Hg)
Metals (specify):
Other (specify):
12.6. Visible emission observations
a.Describe stack characteristics
Location: Height:
Temperature (C): Moisture (%):
Exit dimensions: Orientation
Other information:

b.Describe stack effluent

Plume observed during visit Yes No Colour:
Puffing: Yes No If yes, describe:
Are there sensitive receptors downwind? Yes No
If yes, describe:
12.7. Solid and liquid wastes

a. Describe how and where solid and liquid wastes are treated and/or disposed
Solid:
Liquid:
12.8. Operation and maintenance plans

Does the facility have an Operations and Maintenance Plan? Yes No
If yes, provide comments (date of plan, comprehensive, revisions, etc.):

13. Effluent Treatment Checklist

Applicable: Yes No
13.1. Type of ETP facility:
Municipal Industrial Mixed (municipal and industrial)
Batch treatment Continuous treatment Semi-continuous treatment
13.2. Type(s) of effluent that the facility is permitted to treat:
13.3. How do you decide which types of effluent streams are acceptable for treatment at your facility?
13.4. Effluent volume treated at the facility

ETP daily treatment Average daily Peak daily volume Syngenta average Syngenta peak daily
capacity volume treated treated daily volume volume treated
(m3/day) (m3/day) (m3/day) treated (m3/day) (m3/day)
13.5. Describe the Syngenta effluent streams currently treated at the ETP, if any
13.6. Treatment Processes used at the facility

Equalisation Biological Sand filtration
pH control Chemical oxidation Carbon filtration
Flocculation High temperature evaporation Ultra filtration
Sedimentation Evaporation basin Reverse osmosis
Others Sludge dewatering

Please specify
13.7. Provide a process flow diagram or P&ID detailing the various treatment processes. Sketch below if a
diagram is not available. Indicate the location of the ETP’s discharge points.

13.8. Treatment processes

Treatment No. of Tank Size Flow Rate Retention Time
Tanks (m3) (m3/hr) (hr)
13.9. What operational parameters are monitored for each tank / process and how frequently?
[13.10.] Describe to where the ETP discharges its treated effluent to. Indicate if it is considered a sensitive
receptor e.g. protected catchment area, nature reserve, recreational area, etc
13.10.[13.11.] What parameters are monitored for the ETP’s discharge and how frequently?
13.11.[13.12.] Have there been exceedances of the discharge limits? If yes, please describe (which
parameters, when, how frequently, the root causes, were the authorities informed, actions, fines, etc)

14. Recycling, Treatment Facilities Checklist.

Applicable: Yes No
14.1. Type of facility?
Recycling Treatment
14.2. Processes or unit operations used at facility (check all applicable processes and explain as
necessary):
Biological treatment Distillation
Blending/fuels program Flocculation/precipitation
Chemical fixation Oxidation
Chemical Treatment Physical separation
Dewatering (specify method) Thermal regeneration
Spent solvents Used drums (specify):
Other (specify):
14.3. Describe unit design and operation for each relevant process (attach flow plan, if available):
14.4. Does the facility discharge to an offsite effluent treatment plant? Yes No
If yes, complete the following:
Facility name / location Permit No. Expiration Date
Is discharge to the offsite effluent treatment plant monitored? Yes No
If yes, describe (who performed monitoring, parameters tested and testing frequency):
Has the facility received any violations, notices, or fines? (last 2-3 years) Yes No
If yes, describe:

14.5. Describe outlet(s) for each product, which is reclaimed or generated/regenerated from wastes
treated at the facility (e.g., oil, metals from catalysts)
Product Outlet-Name, Mode of Transport

Address and
Telephone Number
a. Are washed drums or IBCs sold for reuse? Yes No
If yes, describe:
To which companies / industries and how you decide whether they are acceptable
How the washwater is treated and managed
14.6. Product Testing

a. Are reclaimed/regenerated products tested or analysed to ensure quality? Yes No
If yes, describe:
b. Have there been recent complaints or lawsuits regarding product quality? Yes No
If yes, describe:

15. Additional Information to be Provided.

Attach electronically below or to physical document)
1. Map showing the general location of the facility

2. A site drainage map
3. Process flow chart describing the main activities carried out at the facility
4. Site layout, indicating storage areas, landfill, incinerator, etc.
5. Photographs of key features
6. General photographs of the surrounding properties

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Waste Contractor Audit Form

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HSE Management System Document HSE Form

Mandatory Solution 103_4 FOR_Waste Contractor Audit Form_v1.0 (M)

Hazardous Waste Contractor Audit Form

1. General Information (shaded area for Syngenta use only).......................................................................2

Classification: INTERNAL USE ONLY page 1 of 35

Scope of Form: Audit Questionnaire for Waste Management Facilities

1. General Information (shaded area for Syngenta use only)

Site Contact: Name & Title:

Permit Holder (if as above, please indicate)

Contact person: Name: & Title

Operator (if as above, please indicate)

Contact person: Name: & Title

Classification: INTERNAL USE ONLY page 2 of 35

Property Owner (if as above, please indicate)

Contact person: Name: & Title

Environmental/ Engineering Consultants (advised on design and construction, environmental

Contact person: Name: & Title

Classification: INTERNAL USE ONLY page 3 of 35

2.1. Zoning, e.g. industrial, residential, etc.

2.2. What immediately surrounds the facility? North:

Residential and Schools or Day Care facilities:

Wetlands or Flood Plain:

Drinking Water Wells:

Other (please specify):

2.6. Provide a brief history of the site use and ownership.

Classification: INTERNAL USE ONLY page 4 of 35

3.1. Affiliated companies and/or other locations:

Note: a copy of the certificate of insurance must be attached

3.11. Amount of coverage:

3.12. Deductible, if any:

Does it cover closure/post closure? Yes No

Classification: INTERNAL USE ONLY page 5 of 35

Classification: INTERNAL USE ONLY page 6 of 35

Regulatory complaints/notices/fines/suspension of permit

Environmental problems caused by facility that are being addressed:

Classification: INTERNAL USE ONLY page 7 of 35

5.1. Current operations: Yes No Capacity (tons/day)

Hazardous waste / Secure landfill1

Non-hazardous waste landfill1

Deep well injection

Liquid waste treatment

Other (please specify):

Total volume handled per month:

Classification: INTERNAL USE ONLY page 8 of 35

5.3. Type of material handled: Liquid Solid Semi-solid

Drums Bulk Drums Bulk Drums Bulk

Classification: INTERNAL USE ONLY page 9 of 35

5.5. Environmental monitoring:

Are the following areas routinely monitored? Yes No

Residue (e.g. ash, sludge) composition

Other (please specify):

Classification: INTERNAL USE ONLY page 10 of 35

6.2. Is there documentation of the HSE and operational training Yes No

Classification: INTERNAL USE ONLY page 11 of 35

7. General Facility Standards.

7.1. General manager/senior operator on-site:

Name & Title:

7.3. Audits and certificates:

b. Does the facility have a written internal audit program? Yes ✘ No

d. Does the plant maintain an inspection log? Yes No

Provide any additional comments

Classification: INTERNAL USE ONLY page 12 of 35

7.4. Emergency preparedness and prevention:

If yes, is waste separated from sources of ignition or reaction (open flames,