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Crosby & Overton, A Internal Use Only <br /> Waste Product Questionnaire Job Number 47379 <br /> General Information <br /> ^enerator Name Valero Billing Name DECON Environmental Services,Inc. <br /> Areas 2941 Navy Drive Address 23490 Connecticut Street <br /> City,State,Zip Stockton,California 95206 City,State,Zip Hayward,California 94545 <br /> Contact Mr.Von Crites Contact Mr.Jason M.Costello <br /> Phone (209)943-5662 Fax Phone (510)732-0444 Ext 20 Fax (510)7828584 <br /> EPA Number CAT000617514 <br /> WASTE PRODUCT DESCRIPTION AND CHARACTERISTICS <br /> Waste Product Common Name Waste Paint Chips/Scrapinging From Recodilioning Large Gasoline Storage Tank/Reservoir <br /> Process Generating Waste Restoration of Gasoline Storage Tank/Reservoir <br /> A. Hazardous U.S.EPA Hazardous Waste? Yes © No ❑ <br /> Properties: State Code(s) 181 EPA Code(s) D008 <br /> Waste Product: Shock n Sensitive n Reactive n Radioactive n Pyrophodc ❑ Etiological n None <br /> B. Physical Phys.State: Solid ©. Liquid ❑ Any Free Liquids at 70 F? .Yes No ❑ <br /> Properties at 70 F Sludge ❑ Empty Container ❑ <br /> Layers: Mu101ayered ❑ Flash Point <70 F 70-100 F E]101-139F ❑ <br /> Bi-Layered ❑ (Closed Cup Only) 140-200 F ❑No Flash ©Exact I—I <br /> Homogenous —� <br /> Viscosity Water ❑ Honey ❑ <br /> Motar Oil ❑ Other ❑ Solid Waste <br /> C.Density: Liquid Li lbs./gallon %Solids By WeightPh <2 ❑ 9.1-12.5 <br /> Solid El _lbs./cubic ft. .100% By Volume 5-Feb .❑>12.5 <br /> Odor. None 5.1-9 © Exact ❑ <br /> Any debris in waste: Yes © Strong <br /> No ❑ Mild <br /> Explain: Possible PPE Describe: Hydrocarbon Odor <br /> D.Chemical Composition(account for 100%of total) Range Metals: Pesticides.Herbicides•PPM <br /> % Total(PPM) Endrin N/A <br /> °/u EP Toxicity(mg/i) Lindane NIA <br /> Paint Chips 95.0-100 % Arsenic(As) N/A Methoxychior N/A <br /> Lead .0-0.01 % Bariunl N/A Toxaphene NIA <br /> Steel Scrapings .0-5.0 % Cadmium(Cd) N/A 2,4-0 N/A <br /> % Copper(CU) WA 2, 4,STP NIA <br /> % Lead(Pb) <1.0% Other NIA <br /> % Mercury(Hg) N/A Reactives/Other Wastes(PPM): <br /> % Nickel(Ni) N/A Cyanides NIA <br /> % Selenium(Se) N/A Sulfides N/A <br /> % Silver(Ag) N/A HOC N/A <br /> % Zinc(Zn) N/A Dioxin NIA <br /> PCBs N/A <br /> E.Shipping and Handling Information Phenols NIA <br /> D.O.T.Hazardous Material: Yes © No ❑ <br /> Prover Q I SSh ppipa NAma Hazardnu Waste Solid NOR (DrOtl) DO T un7aM r`12k� 9� <br /> D.O.T.ID Number&PG NA3077/PGIII Method of Shipment t x 55-gallon 1A2 Drum amd/or Drum <br /> Bulk: Est.4,000 gal Other: D.O.T.Shiping Cntr 1 x 55-gallon 1A2 Projected Volume <br /> Tons: Gallons: Est.300 lbs. Cubic Yards: Other: <br /> Ru AMM Per One Time X Week <br /> Month Quarter Year Comments <br /> .enerator Certicicatlon statement <br /> I hereby certify that as an authonzed representative of the generalor named above,all information submitted in this and all the attached documen6 is true and/accurate. Analysis of five waste was conducted in <br /> accortance with the appmved test methods in 40 CFR 261 on a repmsentalive sample as defined in 40 CFR 261,20. To the best of my knowledge,all knovm(40 CFR 261)and suspected hazardous components <br /> have been included in this documentation. All malenal and packaging will comply with all cement regulations. <br /> Signature Title: Date: <br />