Waste Determination Request (WDR)

Date

Originator Information

Shop

Contact

Code

Command

Building

Phone Ext

Waste Information
Waste Name:
                           Common:_______________________________________________________

                          Chemical(s)______________________________________________________

Physical Form:                          Liquid                              Solid                                Sludge

National Stock Number

Quantity on Hand

Waste Source (Describe waste generation process if known)

Additional Information

Signature

Code

                                                SUBASE KINGS BAY 5090/03 (Rev.03/07)