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03-05-'15 11 :48 FROM- nles Environmental 661-322-888 T-456 P0001/0001 F-960 <br /> Crosbyyerton hic6 <br /> Internal Use Only <br /> 1 Job Number: <br /> WASTE PRODUCT QUESTIONNAIRE <br /> I,CKNIMALINPORMIATTON FAX (662) 495-2181 96572 <br /> GcaMmtorName Pacific Southwest Irrigation BillbtgNamo COLES ENVIRONMENTAL <br /> Address 8372 S. Jack Tone Road _ Address PO BOX 10764 <br /> City,State,Zip-.9 rkton.CA95215 city,Smte,2i `�l LD,CALIF 93389 <br /> contact Colin Kellv(George Lowes—� Contact MARY MILLER _ �`- W <br /> Phone 209/545-8130 Fax 209/578-T1442— fJ <br /> ED <br /> EPA Number CAL000358877 phone 661/322-8258 fax 661/322 8 <br /> (I.WASTE PRODUCT DESCRIPTION&CHARACTERISTICS <br /> A.Waste product Common Name- <br /> Weldon-On Primer P-70 APR 0 8 2015 <br /> 1.Procass Ganerating Waste Site Cleanup-Dally Operations. <br /> GKI NTAL <br /> B.Hazardous Properties: rice,Tu nconlrr+APplT <br /> 1.U.S.EPA Hazardous Waste? ®Yes ❑No 2. State Code(a): 331 --- <br /> _._--- <br /> EPA Code(s): 4001 <br /> c.Is Waste Product: 0shock sensitive O Reactive ❑Radioactive Q Pyeophorlo ❑Etiological ❑✓ None <br /> C.Physical Properties at 70°F: <br /> 1,Physical State: 2.Layers S.Flash Point(Closed Cup Only): 4.Viscosity similar to: <br /> ❑Solid ❑Sludge ❑Multilayarad ❑%70°F 0140-200-1c ❑Water <br /> 14 Liquid []EMPTY Container Q SI-Layered p 70.1 Co.F []No Flach ❑Motor Oil <br /> ❑Aerosol 0Homogenous ❑101-139°F E]Exact ®Honey <br /> Any tree liquids at 70°F 0 Other <br /> (3 Yea ❑ No <br /> D. 1.Density 2.%Solids 3.Odor 4.Ph. <br /> Llquld&l — lbs/gallon 0 By Weight ❑None 11<2 139.1-12.5 <br /> Solid ❑___._ Ibslcublc h. 08 volume 11 strong 132.5 D>12.5 <br /> Any debris in waste: Total ❑Mild 13 5.1-9 0 Exact <br /> a Yes 0 No Describe: <br /> NONE NONE <br /> Explain <br /> E. Chemical Composition(Account for 100%of total): Hung- Total(PPM) Pesticides.Herbicides:PPM <br /> Primer 100 - 100 % EPToxictly(mglp Endrin. . . . . _ <br /> % Arsenio(As) Lindane. . . - . <br /> MSQ$ L SHEETS ATTACHED ^__% Barium(Be) Metnoxychlor _,,,,,.- <br /> Cadmium(Cd) Toxaphene <br /> % Chromium(Cr) 2,4•D <br /> % Copper(Cu) 2,4,5•TP <br /> ._.�% Lead(Pb) Other, <br /> % Mercury(Hg) <br /> Nickel(Ni) Reaclives&Other <br /> _ - - % selenium(Ss) Wastes(PPM): <br /> I_% silver(Ag) _ Cyanides_Dioxin <br /> - V. Zinc(2n) SUllides__.,,..,._PCBs-__ <br /> F. Shipping and Handling Information: HOC-_Phanolq­— <br /> 1.D.O.T.Hazardous Material?MYcs MNO <br /> 2.Proper D.O.T.Shipping Name: Waste Flammable liquid, n.o.s. (Acetone.Tetrahydrofuran <br /> S.D.O.T.Hazard Class: 3• _ 4.D.o.T.IDNumber LIN1993 __PG:_PGII _ <br /> 5.Method of Shipment:,^ an <br /> rum d/or._.__Bulk___Other 6.D.O.T.Shlpping Contalner. 55"_gi drums GI/4t Cans <br /> 7.Projected Volume:__-Tons_____„,.,_Gallons Cubiti Yards____Other 8.RQ Amount----- <br /> Per 1t04 One Tlme Week—Month--Quarter X. Year <br /> ' Commenle:- —� <br /> r <br /> Ill.GENERATOR CERTIFICATION STATEMENT <br /> I hereby codify that as an authorized representative of the generator named above, all information submitted in this and all attached documents <br /> '� Is true andlacourate.Analysis of the waste was conducted In accordance with the approved test methods In 40 CPR 261 on a representative sample <br /> defined in 40 CFR 261.20.To the best of my knowledge,all known(40 CFR 261) and suspected hazardous components have been included In <br /> This docur riply with all current regulations. <br /> Signature__ TiOs Oate__02/19/15 <br /> FORM402(ROv.03110) <br /> _ li <br />