Aggregate Recycling Corporation

A. Generator Information

Generator Name:

Site Address:

Site City:

Site State:

Technical Contact:

Phone:

B. Site Description

Current Site Usage:

Process Generating
Waste:

C. Material Description

1. Material Type

Coal Ash		Sandblast		Catchbasin Grit
Road Sweepings		Other (please Explain)

2. Approximate the amount of debris in this material: %
(ARC retains the option of charging for debris in excess of 15% unless previous arrangements are made.

GENERATOR CERTIFICATION

By checking the "agree" box below, the Generator certifies:

This waste is not a "Hazardous Waste" as defined by USEPA or State of Maine Regulations
The portions of this sheet and attachments contain true and accurate descriptions of the waste material. All relevant information regarding known or suspected hazards in the possession of the Generator has been disclosed.
The analytical data presented herein or attached hereto were derived from testing a representative sample taken in accordance with 40 CFR 261.20(c) or equivalent rules
If any changes occur in the character of the waste, the Generator shall notify ARC prior to providing the waste to ARC.

I agree to the terms above