Special Waste Discharge Request Form

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Please correct the field(s) marked in red below:

For any questions or form clarification, please contact Paul Bixel, Environmental Compliance Manager, at PDBixel@OlatheKS.org or 913-971-9381.
1
Name of Business
 *
2
Facility Address
 *
3
Contact Information
 *
Contact Information
4
Name and address of facility where waste is to be disposed; if different from above:
5
Name of waste material:
6
How was the waste generated?
7
Was the waste ever classified as Resource Conservation and Recovery Act Hazardous Waste?
Was the waste ever classified as Resource Conservation and Recovery Act Hazardous Waste?
8
Waste Composition:  (If lab analysis is available, email: PDBixel@OlatheKS.org)
9
Volume for Disposal:
10
Additional Comments: 
11
"I have personally examined and am familiar with the information submitted in this survey.  Based upon my inquiry of those individuals immediately responsible for obtaining information reported herein, I believe that the submitted information is true, accurate, and complete.  I am aware that there are significant penalties for submitting false information, including the possibility of fine and/or imprisonment."
 *
"I have personally examined and am familiar with the information submitted in this survey. Based upon my inquiry of those individuals immediately responsible for obtaining information reported herein, I believe that the submitted information is true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and/or imprisonment."
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