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'� 110534 <br /> CROSBY & OVERTORINC . PROFILE <br /> PH : ( 562 ) 432 , 5445 <br /> WASTE PRODUCT QUESTIONNAIRE FAX : ( 562 ) 495 . 2181 <br /> GENERAL INFORMATION <br /> Generator Name : Tesoro Stockton Terminal Billing Name : American Integrated Servcies <br /> Site Address : 3003 Navy Drive Address: 1502 E Opp Street <br /> City I State I Zip : Stockton CA 95206 City I State I Zip : Wilmington CA 90744 <br /> Contact: Lucina Lopez Contact: <br /> Phone: 562-728-2265 Fax: Phone: 310-522-1168 Fax: <br /> EPA ID Number: CAT000618637 <br /> WASTE PRODUCT DESCRIPTION AND CHARACTERISTICS <br /> Waste Product Common Name : BROKEN GLASS ( NON RCRA) <br /> Generating Waste Process : SITE CLEAN UP _ <br /> A . Hazardous Properties B . Physical Properties <br /> U .S . EPA Hazardous Waste ? Yes * No Physical State: • Solid Liquid Sludge Aerosol Empty Container <br /> State Code(s) Any free liquids at 706F : Yes No Color: <br /> 352 Layers: Multi - Layered Flash Point < 70°F 70-1o0"F 101 - 139°F <br /> EPA Code ( s) Bi-Layered (Closed Cup Only) 140-200°F • No Flash Exact <br /> N/A <br /> Waste Product: Homogenous <br /> Shock Sensitive Reactive Radioactive Viscosity : Water Honey Motor Oil Other <br /> Pyrophoric Etiological None <br /> C. Density D, Misc. Regulatory <br /> Liquid lbs/gallon %Solids : By Weight By Volume Source Code : <br /> Solid lbs/cubic ft . pH : <2 2-5 5 . 1 -9 Form Code: <br /> 9. 1 - 12 .5 > 12.5 Exact <br /> Any debris in waste ? Yes No Odor: * None Mild Strong L.A. Country Sanitation District Category: <br /> Explain : Describe: Oil Organics <br /> E. Chemical Composition (account for 100% of total ) RANGE METALS PESTICIDES/HERBICIDES ( PPM ) <br /> EMPTY SAMPLE GLASS JARS 100 % Total ( PPM ) Endrin <br /> SOIL 1 -100 % EP Toxicity (mg/1 ) Lindane <br /> GRAVEL 1 -100 % Arsenic (As) Methoxychlor <br /> PPE , GLOVES , RAGS , PADS , PLASTIC , WOOD , ABSORBENT 1 -100 % Barium (Ba ) Toxaphene <br /> PLASTIC PIPES , METAL PIPES , FITTING , TANK SEALS 1 -100 0,o Cadmium ( Cd) 214-D _ <br /> SANDBLAST GRIT 1 -100 06 Chrome (Cr) 2,4,5 -TP T� <br /> PETROLEUM HYDROCARBON 1 -20 0% Copper (Cu ) Other <br /> OIL 1 -30 0o Lead (Pb) <br /> CARDBOARD REACTIVES/OTHER WASTES ( PPM) <br /> 1 -20 Mercury ( Hg) <br /> METAL DEBRIS (STEEL , ALUMINUM, CAST IRON ) 1 -15 % Nickel (Ni ) Cyanides <br /> CONCRETE CEMENT ( IN PIECES ) 1 - 100 Sulfides <br /> CARBON 1 -100 % Selenium (Se) Halides <br /> % Silver (Ag ) Dioxin _ <br /> % Zinc (Zn) PCBs <br /> F. Shipping and Handling Information Phenols <br /> D. O.T. Hazardous Material : • Yes No <br /> D.O.T. ID Number : N/A Proper Shipping Name: NON RCRA HAZARDOUS WASTE SOLID (BROKEN GLASS JARS and DEBRIS) <br /> D.O.T. Hazard Class : N/A PG: N/A <br /> Method of Shipment: _ Drum : Bulk : Other: <br /> D. O.T. Shipping Container : DM / CYB Projected Volume: Gallons : Cubic Yards : RQ Amount: <br /> COMMENTS : ****NEEDS TO WEIGH ALL DRUMS AND ATTACHED A COPY OF THE WEIGHT TICKETS TO THE INVOICE*** <br /> *******FINAL TSD : US ECOLOGY********** * <br /> Generator Certification Statement <br /> I hereby certify that as an authorized representative of the generator named above, all information submitted in this and all the attached documents is true and accurate. <br /> Analysis of the waste was conducted in accordance with the approved test methods in 40 CFR 261 on a representative sample as defined in 40 CFR 261 . 20. To the best of my <br /> knowledge, all known (40 CFR 261 ) and susperdous components have been included in this documentation . All material and packaging will comply with all <br /> current regula <br /> Signature Print Name : Lucina Lopez Title : Sr. Environmental Eng Date : 12/19/2018 _ <br /> (Print, sign and send to custon e ervicei <br />