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02-252 15 15:14 FROM- 0s Environmental 661-322-8883 T-440 P0002/0002 F-919 <br /> � <br /> internal <br /> VIM <br /> Crosby &05 <br /> Vel® Inc® <br /> Job Number: <br /> WASTE PRODUCT QUESTIONNAIRE <br /> I, FAX (562)495-2181 - 96571 <br /> GenerntorNamePaciftcSouthwest Irrigation )3181rtgNatnaCOLESENVIRONMENTAL <br /> Address 37$ 2 S ,Ick Tone Road Address PO BOX 10764 <br /> City,State,z;p_$(cr p C 95 City,Smte,VIE BASE SFl�LD, CALIF 93389 <br /> Concoct Colin a V( eorge owrv) contact MARY MILLER _ r <br /> Phone 8 D rax 209/578-0142 Pbane 661/322-8258 pox 661/322-888 �/r <br /> EL <br /> EPA Number CAL000358877 <br /> II.WASTE PRODUCT DESCRIPTION&CHARACTERISTICS <br /> A.Waste Product common Name dhesive(Weldon-On Products) APR 09 2015 <br /> 1.ProcesBeem daring Wavle Site Cleanup-Daily Operations <br /> 6.Hazardous roperses: _ HcA,Tuneoeo?�eenlAI, <br /> 1.U.S.EPAHazardous Wasto? ®Yes []No 2. State Cade(s): 331 _ _ <br /> EPA Codo(s): D001 <br /> c.Is Waste Product: 03hockSensllive 11Reactive ❑Radioaclive ❑Pymphorlc ❑Etiological ❑✓ None <br /> C.Physical Properties at 70°F: <br /> 1.Physical state: 2.Layers 3.Flesh Point(Cfosed Cup Only): 4.Vfruwity similar to: <br /> ❑Solid r]Sludge ❑Muliilayamd D c70°F D40-1200'F ❑Water <br /> 0 Liquid []Empty Container p 81-Layored [370-100'F ❑No Flash ❑Motor Oil <br /> ❑Aerosol . 0Homogenous ❑101-130°F I]Exaci,_.,_ ❑Honey <br /> Any free liquids at 70'F 0 Other <br /> ❑Yes 17 No <br /> D. 1.Density 2.%Solids a.Odor 4.Ph, <br /> Liquid Q-, lbs/gallon 08y We[ghl ❑None E1<2 ❑9.1-12.5 <br /> Solid D—. lbs/cublc ft. Eley volume ❑Strong 112-5 0a12.6 <br /> Any debris in waste: Total ❑Mild ❑5.1-9 ❑ExaaI— <br /> mYos ONO Deecrlbs: <br /> ` Repiain <br /> MGEA1 NONE NONE <br /> H. Chemical Composition(Account for 100%of total): Renee Total(PPM) Peslicides,Herbicides:PPM <br /> Adhesive 100 - 100 '6 _--____EPTcxlolty(mgll) Endrin. . . . . _ <br /> Arsenio(As) Undane. . . . . <br /> MSDS SHEETS ATTACHED — % . Sedum(Sa) MelhoXyohlor <br /> cadmium(Cd) Toxaphene <br /> Chromium ICE) 2A-D <br /> Copper(Cu) <br /> T. Lead(Ph) Other ' <br /> Mercury(Hg) <br /> Nickel(Ni) Reecuves&Other <br /> -- - <br /> �• - % Selenium(Sal Wastes(PPM): <br /> P Silver(Ag) Cyanldes_Dioxln_ <br /> % Zinc(Zn) Suliidoa,__PCBs <br /> F shipping and Handling Information: t HOC Phenols <br /> 1.D.O.T.Hazardous Matedal?myee,:]JJo <br /> .,2.Proper D.O.T.Shipping Name: UNI 133,Waste Adhesives, fcontaintng a flammable liouidl, <br /> s.D.O.T.Hezard Class: 3, 4.D.O.T.ID Number:UN1133 PG: PGII _ <br /> S.Method of Shipment:__ Orum andlor_-_Bulk—..-Other 6.D.O.T.Shipping Goniainer'55-g1 drums (GI&Qt cont) <br /> 7.Proleoled•Volume: Tons Gallons CubloYards lher e.RQAmount__ <br /> Per—I(04 One Time Week Month___.__ ,Quarter x Year <br /> Cammenls: <br /> ` *III.GENERATOR CERTIFICATION STATEMENT <br /> I hereby codify[hat as an authorized representative of tine generator named above,all information submitted in this and all attached documents J <br /> is tate andlaccumte.Analysis of the waste was conducted to accordance with the approved lest methods In 40 CFR 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 hafardous components have boon Included in <br /> Thisdocur 'ten •nplywllhall current regulations. <br /> Signature -yr/�y 1, i /Y� — -..--Tills _—Dalc-02!19/15 <br /> !y�N'�`� FORM 402(Ray.03110) <br />