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03-05-' 15 11 :48 FROM- les Environmental 661-322-8880 T-456 P0001/0001 F-960 <br /> Crosby Overton Inc. Internal Use Only <br /> Job Number: <br /> WASTE PRODUCT QUESTIONNAIRE <br /> 1,CENERAL,INPORVIATION FAX (662)495.2181 96572 <br /> Generator Name Pacific Southwest Irrigation 111hhtgNan,o COLES ENVIRONMENTAL <br /> Address 8372 S. Jack Tone Road _ _ Address PO BOX 10764 <br /> city.state.Zip��irkton.CA 9571F city,stote v.p SA �l LD, CALIF 93389 <br /> Contact Colin Keliv(Georae Lowrv�� Contact- MARY MILLER <br /> Phone - rax 209 578-0 4 Phone 661! <br /> RPA Number CAL000358877 322-8258 Pax 661/322-8883 <br /> II.WASTE PRODUCT DESCRIPTION&CHARACTERISTICS <br /> A.Waste product Common Name Weldon-On Primer P-70 <br /> 1.Process Generating Waste Site Cleanup-Daily ODerati4n$ <br /> B.Hazardous Propartlea: <br /> 1.U.S.EPA Hazardous Waste? ®Yes ❑NO 2. State Code(s): 331 -- <br /> EPA Code(s): D001 <br /> c.Is Waste Product; DShocu Sensitive O Reactive D Radioactive 0 Pyropimrlo D 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 ❑Multilayered D 40°F ❑140.200°F ❑Water <br /> Ell Liquid Empty Container ®SI-Layerad ❑70.100°F 0N Flash ❑Motor Oil <br /> 0 Aerosol 0Homogenous ❑101-139°F ❑exact_ ®Honey <br /> Any free liquids at 70°F 0 Other <br /> l7 Yes O No <br /> D. 1.Density 2.%Solids 3.Odor 4.Ph. <br /> Liquid VI — Ibsrgalion 0 By Weight D None 042 D 9.1.12.s <br /> Solid ❑ Ibslcubic h. 11 BY Volume ❑Strong 02.5 D>12.5 <br /> Any debris in waste: Total ❑Mild O 1-1-6 13 Exact_ <br /> C• m Yes 0 No Describe: <br /> Explain <br /> M-lal NONE NONE <br /> E. Chemical Composition(Account for 100%of total): 9abga_ _ Total(PPM) Pesticides.Herbicides:PPM <br /> Primer 100 — 100 % 6PToxlclly(mg10 Endrin. . . . . <br /> —% Arsenic(As) Lindana. . . . . <br /> (yjSDS SHEETS ATTACHED — % Barium(Ba) Matnoxychlor - <br /> -{� % Cadmium(Cd) Toxaphene <br /> 111"1// A Chromium(Cy) 2,4•0 <br /> % Copper(Cu)-,�_...,� 2.4,5•TP -- <br /> _ % Lead(Pb) Other <br /> Tp1' % MercuryEN <br /> (Hg) <br /> I rv1n_"/ Nickel(Ni) Ra rtes(s&Other <br /> T FPARTUI�PIT — % Selenium(Se) Wastes(PPM): <br /> Silver(Ag) _ Cyanides—Dioxin <br /> Zinc(Zn). Sulfides-­PCBs <br /> F. Shipping and Handling Information: HOC Phenols, <br /> 1.D.O.T.Hazardous Material?MYes nNo <br /> e.Proper O.O.T.shipping Name: Waste Flammable liqu(d, n.o.s.jAcetone,Tetrahydrofuran <br /> S.D.O.T.Hazard Class: 3, 4.D.O.T.ID Nur/lbsr-UN 1993 pG:_PGII__w_,__ <br /> 6.Method of Shipment:,__ rum andlor-..--Bulk---Other 6.D.O.T.Shipping Contalner. 55-81 drums GVQt Cans ,,, <br /> 7.Projected Volume:. —Tons_Gallons Cubic Yards-__T-Other 8.RO Amount .— <br /> Per_Ito4 One Time Week Month---Quarter x_ Yoar <br /> Comments: <br /> Ill.GENERATOR CERTIFICATION STATEMENT <br /> r I hereby certify 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 bent of my knowledge,all known(4o CFR 261) and suspected hazardous components have been included In <br /> this docur nply with all current regulations. <br /> ! <br /> Signature-- ,yY�,%�e,�` , _—_— Tille�W FORM M <br /> 4✓� tut_Jcs••�v f12(Rev.=3/10) <br />