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Crosby and Overton , Inc , WASTE PRODUCT QUESTIONAIRE 110534 <br /> I. GENERATOR INFORMATION <br /> Generator Name: TESORO STOCKTON TERMINAL Billing Name: AMERICAN INTEGRATED SRVS** * <br /> Address: 3003 NAVY DR Address: 1502 E. OPP STREET <br /> City , State Zip STOCKTON , CA 95206 City , State, Zip WILMINGTON , CA 90744 <br /> Contact: Contact: REGGIE SANTOS <br /> Phone: Phone: <br /> Fax: Fax: 310-522-0474 <br /> EPA NUMBER: CAT000618637 <br /> Expiration Date: 19-DEC-19 <br /> II. WASTE PRODUCT DESCRIPTION & CHARACTERISTICS <br /> A. Waste Product Common Name : NON RCRA SOLID - BROKEN GLASS, DEBRIS *WEIGHT TICKET* US ECOLOGY DISPOSAL <br /> Process Generating Waste : SITE CLEAN UP <br /> B. Hazardous Properties : State Code(s) EPA Code(s ) <br /> 1 . US EPA Hazardous Waste? 352 <br /> 3. Is Waste Product Shock Sensitive Reactive Radioactive Pyrophoric Etiological X None <br /> C. Physical Properties at 70 deg F. <br /> 1 , Physical State: 2. Layers 3. Flash Point (Closed Cup Only ) 4. Viscosity , similar to: <br /> SOLID MULTILAYERED NONE SOLID <br /> D. 1 . Density: <br /> 1 , Density 2. % Solid 3. Odor 4. PH <br /> = 60 LBIFT3 = 100 % 5. 1 - 9 PH <br /> Any debris in waste : <br /> Explain : <br /> E Chemical Composition (Account for 100 % of total) Range Metals TTLC: Copper: <br /> CARBON 1 100 % Total (PPM) Lead: <br /> CARDBOARD 1 20 % EP Toxicity (mg/1) Mercury : <br /> CONCRETE CEMENT (IN PIECES) 1 100 % Antimony : Nickel: <br /> EMPTY SAMPLE GLASS JARS 0 100 % <br /> GRAVEL 1 100 % Arsenic: Selenium:METAL DEBRIS(STEEL, ALUMINUM CAST IR 1 15 Barium : Silver: <br /> OIL 0 10 % Beryllium: Zinc: <br /> PETROLEUM HYDROCARBON 0 10 a° Cadmium : Molybdenum : <br /> PLASTIC PIPES, METAL PIPES, FITTING,TAN 0 100 Chromium : Thallium: <br /> PPE, GLOVES, RAGS, PADS, PLSA11C, WOOD, 1 100 <br /> SANDBLASTGRIT 1 100 % Cobalt: Vandium : <br /> SOIL 1 100 % <br /> Reactives, & Other Pesticides Herbicides : <br /> Wastes (PPM): Endrin: <br /> Cyanides : Lindane <br /> Dioxin: Methoxychlor: <br /> Sulf ides : Toxaphene: <br /> PCBs : <br /> P24D: <br /> HOC : P245TP: <br /> Phenols: <br /> POther: <br /> F. Shipping and Handling Information : <br /> 1 . D . O.T. Hazardous Material? 2, D . O.T, Shipping Name: NON RCRA HAZARDOUS WASTE SOLID <br /> 3. D . O.T. Hazard Class : 4. D . O.T. ID Number: Packing Group: <br /> 5. Method of Shipment: DrumX Bulk_ Other 5, D . O.T. Shipping Container: <br /> 7, Projected Volume: <br /> Comments : <br /> GENERATOR CERTIFICATION STATEMENT: I hereby certify that as an authorized representative of the generator named above, all information submitted in this and all the <br /> attached documents is true and accurate. Analysis of the waste was conducted in a ccordance with the approved test methods in 40 CFR 261 on a representative sample as defined <br /> in 40 CFR 261 . 20. To the best of my knowledge, all known (40 CFR 261 ) and suspected hazardous components have been included in this documentation. Al material and packaging <br /> will comply with all current regulations. <br /> Generator's Authorized Signature Title Gate <br />