Hazardous Waste Profile Sheet (WPS)

This content was archived on June 24, 2013.

WPS No.
Manifest No.
Name of Waste Stream and/or Waste Class No.:
Waste Management Company:
Provincial Licence No.:
Address:
Telephone #:
Fax #:
E-mail:
Date of Collection (dd/mm/yy):

SECTION 1: GENERATOR INFORMATION

Generator Name:
Address:
Telephone #:
Fax #:
E-mail:
Provincial Generator Registration No.:

Waste Stream Info:
Quantity:
Frequency:
Container:

WPS Prepared by:

For Office Use Only:
Approved by:
Process code:

SECTION 2: HAZARD CLASSIFICATION

1. WHMIS Class(es): (please check)

• Class A
• Class B1 B2 B3 B4 B5 B6
• Class C
• Class D1 D2 D3
• Class E
• Class F

2. TDG Information:

PIN:
TDG Class:
Packing Group:
Type of Packing Group:
Shipping Name:

3. Other Hazard Information:

1. Ozone Depleting? Y N
2. Scrap Metal? Y N
3. Radioactive? Y N
4. Rocks > 15mm Y N
5. Concrete debris < 15mm Y N

SECTION 3: CHEMICAL COMPOSITION OF WASTE

1. Ingredients

LD₅₀ for Mixture (if available):
Total: %
LD₅₀ (specify species and route)
Occupational Exposure Limits
LC₅₀ (species)
LC₅₀ for Mixture (if available):

2. Metals (ppm)

• Arsenic
• Barium
• Cadmium
• Chromium
• Cobalt
• Copper
• Lead
• Leachable
• Mercury
• Nickel
• Selenium
• Silver
• Thallium
• Vanadium
• Zinc
• Total

3. No Metals

4. Other Components (specifically identify):

• Cyanides
• Dioxins
• Furans
• Halogens
• PCBs
• Pesticides
• Phenolics
• Sulfides
  
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SECTION 4: PHYSICAL CHARACTERISTICS OF WASTE

Colour:
Evaporation Rate:
pH:
Odour Threshold:
Boiling Point:
Specific Gravity:
Density:
Heat Content:

Physical State %

• Liquid
• Solid
• Gas
• Aerosol
• Powder
• Sludge
• Lab-pack
  

Other Properties of a Liquid, Paste or Sludge

• Layers
  • Single Phase
  • Bi-layered
  • Multi-layered
• Viscosity
  • Low
  • Medium
  • High
• Free Liquids
  • Yes
  • No
  • Volume %

SECTION 5: FIRE/EXPLOSION/REACTIVITY DATA

1. Flammability Data

Flammable? Yes No
If yes, under what conditions?
Means of Extinction:
Flash Point Estimate: (specify exact f.p. if known):
< 23°C : 23 - 60°C : 61 - 93°C : > 93°C

Upper flammable limit:
Lower flammable limit:

2. Reactivity Data

Chemically stable? Yes No
Incompatible Substances:
Reactivity Conditions:

SECTION 6: HEALTH HAZARDS/ TOXICOLOGICAL PROPERTIES

Routes of Entry:

• Skin Contact
• Skin Absorption
• Eye Contact
• Inhalation
• Ingestion
  

Effects of Acute Exposure:
Effects of Chronic Exposure:

• Irritant
• Carcinogen
• Teratogen
• Sensitizer
• Reproductive Toxin
• Mutagen
  
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SECTION 7: PREVENTATIVE MEASURES

Specific Protective Equipment:

• Respirator:
• Eyewear:
• Gloves:
• Clothing:
• Other:

Safe Handling Procedures & Equipment:
Storage Requirements:

SECTION 8: FIRST AID MEASURES

Specific Measures for:

• Eye Contact:
• Skin Contact:
• Inhalation:
• Ingestion:

SECTION 9: GENERATOR ATTESTATION STATEMENT

I hereby attest that all information submitted in this and all attached documents is complete and accurate to the best of my knowledge and all known or suspected hazards have been disclosed. Also, I certify that the materials tested are representative of all materials described on this waste profile sheet.

Authorized by:
Date:

SECTION 10: ADDITIONAL INFORMATION

Additional Pages Attached: Yes No
If yes, how many

MSDS Attached: Yes No
If yes, how many

Comments:
Note:
N/AV = Not Available
N/AP = Not Applicable
N/E= Not Established