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02-25-' 15 15:14 FROM- Environmental 881-322-88830 T-440 P0002/0002 F-919 <br /> internal use only <br /> & V ®n/ Incoclu <br /> Job Number: <br /> WASTE PRODUCT QUESTIONNAIRE <br /> 1,OrNISTRALINFORMATTON FAX (562)495-2181 96571 <br /> Conerntor Name Pacific Southwest Irr)gation nillingName COLES ENVIRONMENTAL <br /> Add,reaa_37$ 2 S @Ck Tone Road - Address PO BOX 10764 <br /> City,State,Zip �r p C 95 City,Stato,Zip BAR tSFTELD,CALIF 93389 <br /> Contact Colin-KeI)v( eorge owrv) Contact MARY MILLER _ �r <br /> Phone 2091545-8130 pax 209/578.0142 phone 661/322-8258 Fax 681/322-8883 n Y <br /> e�v ELi <br /> EFA Number CAL000358877 r <br /> II.WASTE PRODUCT DESCRIPTION&CHARACTERISTICS <br /> A.Waste Product common Nama_Adhesive (Weldon-On Products) 8 2015 <br /> 1.Proceaa Generating waste Site Cleanup-Daily Operations <br /> B.Hazardous Properties; _ RM <br /> ENTA� <br /> 1.U.S.EPA Hazardous Waste? ®Yes ❑No 2. state code(a); 331 _�,jrn•Tnn�ns7T�aCAtT <br /> EPA Code(s): D001 <br /> e,Is Waste Product: OShocle Sensitive 0 Reactive ❑Radioactive ❑Pyrophorlo ❑Etiological Q✓ Nona <br /> C.Physical Properties at 70'F: <br /> 1.physical State: 2.Layers a.Flesh Point(Closed Cup Only): 4.Viscosity similar to: <br /> ❑Solid ❑Sludge ❑Multilayered D azo'F ❑140-200°F ❑Water <br /> 0 Liquid []Empty Container D 81-Layered D 70-100'F []No Flash ❑Motor Oil <br /> ❑Aerosol 0 Homagenous ❑101-139°F ❑Exact El Mortal? <br /> Any free ligdlda at 70'F 0 Other <br /> ❑Yes ❑No <br /> D. 1.Density 2,%Solids a.Odor 4.Ph. <br /> Liquid Irk Iba/gallon 0 By Weight ❑None 13<2 ❑9.1-12.5 <br /> Solid ❑—._ lbs/cublc it. 11 BY volume ❑Strong ❑2-5 13>12.5 <br /> Any debris in waste: Total ❑Mild 115.11-9 ❑EXant_ <br /> (71 Yes 0 No Describe: <br /> \.. E3lplain -- <br /> Metele NONE NONE <br /> E. Chemical Composition(Account for 1001%of total): Ration Total(PPM) Pesticides,Herbicides:PPM <br /> Adhesive 100 - 100 % ` EP Toxicity(mg/1) Endrin. . . . . <br /> '/' Arsenic(As) Undane. , . . <br /> MSDS SHEETS ATTACH9D - _ <br /> V. earlum(ea) MalhoXyohlor -,-• <br /> % Cadmium(Cd) Toxaphene <br /> chromium(Cr) 2.4-P <br /> N< <br /> Copper(Cu) 2,4,5-TP <br /> Lead(Pb) Other <br /> % Memury(Hg) <br /> /, Nickel(Ni)_ Reactives&Other <br /> ----- <br /> — % Selenium(Be) Wastes(PPM): <br /> ?/, Silver(Alf) Cyanides_Dioxin <br /> -� % Zinc(Zn) Sullidert__PCBs.— <br /> F Shipping end Handling Information: HOC Phenols <br /> 1.D.O.T.Hazardous Material? ,Yea•(w]No <br /> .,2.Proper D.O.T.Shipping Name: UN 1133,Waste Adhesives !containing a flammable)iauidl. <br /> s.D.O.T.Hezard class: 3, ,_,-.,• 4.D.O.T.ID Number UN1 333 _PG: PGII _ <br /> 5,Method of Shipment: Drum and/or__._Bulk--,.._Other 6.O.O.T.Shipping Container. 55-ol drums (GI&Qt cont) <br /> 7.Projected Volume: Tons Gallons Cubic Yards Other 8.RQ Amount <br /> Per_ fo 4 One Time Weak -Month_.,Quarter X Year <br /> Comments: <br /> III.GENERATOR CERTIFICATION STATEMENT <br /> I hereby certify that as an authorized representative of[tie 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 CFR 261 on a representative sample <br /> defined In 49 CFR 281.20.To the best of my knowledge,all(mown(40 CFR 261)and suspected hazardous components have been Included in <br /> this docur nply with all cunonl regulations. <br /> Signature— -gw/, i --- ...—Ti6e — —Date .02!19/15 --- <br /> 7 FORM 402(Bo¢03/10)- <br />