EMERGENCY RESPONSE*

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*Limited to current customers and active approvals

Liquid Industrial By-Product Re-Approval Notice Form

Liquid industrial by-product re-approval notice Form

Thank you for selecting Liquid Industrial By-Products, Inc. (LI) as your environmental management partner. To extend an expiring by-product approval or in the event that a by-product stream or process has changed, the generator may use this form to re-approve the by-product profile.

Please select one of the following options:

Generator Certification:

I certify and warrant to Liquid Industrial By-Products (LIBP) as follows: (1) all of the information contained on this by-product Re-approval form and attachments, if any, is accurate and complete as of the date of execution and, if re-approved by LIBP, will remain accurate as of the date of any and all pick-ups or delivery to LIBP; (2) the by-product is non-hazardous as defined in applicable federal, state or local statutes, rules, or ordinances; (3) this certification and warranty are based on my personal knowledge of the stream, the information presented, or my inquiries of the person(s) responsible for providing such information; and (4) I am authorized to execute this Re-approval on behalf of the generator identified on this form. I agree to contact LIBP, if there are any future changes in the nature of the by-product(s) sent to LIBP. I will provide updated information, a new Profile as necessary, and additional information (like SDSs) well in advance of the following required pick-up date, allowing adequate review of the new stream and information.

MM slash DD slash YYYY

For Liquid Industrial use only


Approved to extend

Not approved to extend 		New expiration date: ___________________________

Reason: ________________________________________

Please return completed document to Liquid Industrial By-Products, Inc.