Waste Express, IncŽ
6300 Stadium Drive Kansas City, MO 64129 Phone: 1-888-429-9278 816-924-5884 Fax: 1-816-924-1453
express@waste-express.com	*"Life is full of enough headaches -- waste disposal shouldn't be one of them."*

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Company
Address
EPA ID Number
State ID Number
Technical Contact
E-mail
Name of waste
Process generating waste
Physical state @70° F
Free liquids	Yes No
Pumpable?	Yes No

Pourable?	Yes No
Corrosivity
Specific gravity
Flash point
Ignitable (if solid)	Yes No
Composition (if known)
% Total Solids
% Suspended Solids
% Dissolved Solids
% Free Liquids
Chemical Composition
Chemical	Min-Max Range %
	%
	%
	%
	%
	%
Total	%
Shipment Method Quantity
USEPA Hazardous Codes (if known)
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