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CROSBY&OVERTORINC. PROFILE # 110534 <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:SITCLEAN UP <br /> A.Hazardous Properties B.Physical Properties <br /> i <br /> U.S.EPA Hazardous Waste? Yes •No Physical State: • Solid Liquid Sludge Aerosol Empty Container <br /> State Codes) Any free liquids at 70"F: Yes No Color: <br /> 352 Layers: Multi-Layered Flash Point <70`F 70-100"F 101-139°F <br /> EPA Code(s) Bi-Layered (Closed Cup Only) 140-200°F !No Flash Exact <br /> f N/A <br /> II 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: <br /> 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 % Cadmium(Cd) 2,4-D <br /> SANDBLAST GRIT 1-100 q% Chrome(Cr) 2,4,5-TP <br /> PETROLEUM HYDROCARBON 1-20 % Copper(Cu) Other <br /> OIL 1-30 % Lead(Pb) REACTIVES/OTHER WASTES(PPM) <br /> CARDBOARD 1-20 % Mercury(Hg) <br /> METAL DEBRIS(STEEL,ALUMINUM,CAST IRON) 1-15 Nickel(Ni) Cyanides <br /> q, <br /> CONCRETE CEMENT(IN PIECES) 1-100 ° Sulfides <br /> CARBON 1-100 °�0 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 I 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 iin 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 CFH 261) and suspected hafdous components have been included in this documentation_ All material and packaging will comply with all <br /> current reguly <br /> Signature Print Name:Lucina Lopez Title: Sr.Environmental Eng Date:12/19/2018 <br /> (Pont,sign,end send tocustor r itavire} <br />