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Material Profile Form

Material Profile Form

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Send Samples To:

Phibro-Tech Inc.

8851 Dice Road

Santa Fe Springs, CA 90670

A. General Information
Same as above

B. Description of Material
Generator's Common

Must be Surplus Material as defined in 22 CCR 66266.6 (a)(2)

C. Manifest and Labeling Information:
RQ

D. Characteristics of Material:

E. Metals Total PPM:
F. Chemical Composition:
%

(Please list all constituents in the material. Ranges are ok as long as they equal a minimum of 100%)

H. Anticipated Annual Volume:
Quantity Option
Container Type (Select all that apply)

I. Special Handling or Additional Information:
Accepted file types: doc, pdf, Max. file size: 16 MB.

J. I hereby certify that through generator knowledge and/or chemical analysis, all information submitted in this and all attached documents is complete, accurate, and that all known or suspected hazards have been disclosed. I also certify that the sample submitted with this document was collected using the appropriate sampling technique, so as to be representative of the actual stream. I also certify that the sample is properly classified, packaged, marked, and labeled and that the package is in proper condition for transportation according to DOT regulations.
Date*

SAMPLE REQUIREMENT NOTICE: A representative sample of the material must be submitted with all profiles for analysis. Samples must be sent to: Phibro-Tech, Inc 8851 Dice Road, Santa Fe Springs, CA 90670, Attention: Customer Service

Phibro Animal Health Corporation

Corporate Office: Glenpointe Center East, 3rd Fl, 300 Frank W. Burr Blvd Ste 21, Teaneck, NJ 07666-6712 · (201) 329-7300

SEND SAMPLES TO: Phibro-Tech, Inc. 8851 Dice Road Santa Fe Springs, California 90670 · (800) 777-1850

Phibro Animal Health Corporation For further inquiries, contact PTIService@pahc.com

Date: {TD}

Dear Customer,

Congratulations, the following profile has been approved for recycling at Phibro-Tech, Inc. under our Environmental Recovery Service (ERS). We appreciate the opportunity to manage this material for you.

  • Generator Name: {GeneratorName}
  • Material Name: {MaterialName}
  • ERS (Profile) Number: {ERS}
  • Expiration Date: {ExpirationDate}
  • Price Code: {PriceCode}

The following pricing will apply {Pricing}

Standard Pricing Rules:
  • 1) Resource & Recovery Fee of 20% applied to every billable order.
  • 2) All Disposal pricing is FOB Phibro-Tech Inc., 8851 Dice Rd. Santa Fe Springs, CA. 90670.
  • 3) Non standard container sizes are billed as special pricing.
  • 4) Profiles are priced at the time of profile approval.
  • 5) Pricing to be reviewed at profile renewal.
  • 6) All disposal is via Wastewater Treatment unless otherwise specified.
  • 7) $100 minimum fee per manifest.
  • 8) $35 Manifest fee per manifest.
  • 9) IBC's with < 225 gallons will be billed at 225 gallons.
  • 10) $50 surcharge per non-conforming container including totes, overpacks, and broken pallets.
  • 11) $15 per drum if not on pallets.
  • 12) $400 per drum for offsite disposal of drums with solids.
  • 13) $100 surcharge for IBC’s with significant solids.
  • 14) $100 per labor hour per person for non-standard waste off-loading work.
  • 15) $250 fee for unscheduled loads, no show for scheduled or reoccurring loads, or same day cancellation.
  • 16) $250 Emergency profile fee for new or expired wastes that need to be sampled on arrival.
  • 17) Safety Surcharge for high risk waste streams requiring extra handling or waste streams with free chlorine: Bulk $4,000 /Tote $1,000. Drums based on tiered sizes largest to smallest: $400/$300 /$200 /$100
  • 18) Spent ammonia and cupric non-conforming charge: $1.00/gallon Nickel > 50 PPM or Iron > 200 ppm.
  • 19) $250 for weekend scheduling based on PTI availability.

PHIBRO-TECH, INC HAS THE APPROPRIATE PERMIT(S) FOR, AND WILL ACCEPT, THE HAZARDOUS WASTE APPROVED UNDER THIS PROFILE.

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