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02-25-'15 15:14 dF'�ROM- C* Environmental 661-322-8883 A T-440 P0002/0002 F-919 <br /> Crosby &['1'0,1111Ver[o 111co Internal use only <br /> RRR���� rr 6 J �i Job Number: <br /> , <br /> i <br /> WASTE PRODUCT QUESTIONNAIRE <br /> 1.GCNIMALINFORMATION FAX (562) 495-2181 - 96571 <br /> GeneratorNnmePacifc;Southwest Irrigation 'BIghigNameCOLESENVIRONMENTAL <br /> Addreea_38 72 S.4q k Tone Road - Address PO BOX 10764 <br /> City,State,zip_�� p, CA 95 15 BAR 2S lELD,CALIF bid— �"' <br /> 9 cont ct Zip F <br /> contact Colin Kelly( eo�oWTV) contact MARY MILLER _ <br /> Phone -8 0 rax 2091578-0142 <br /> EPA Number CAL000358877 Phone 661/322-8258 Pox 661/322-8 8 <br /> II.WASTE PRODUCT DESCRIPTION&CHARACTERISTICS APR 0 S 2015 <br /> A,Waste Product common Nam Adhesive(Weldon-On Products <br /> 1.Process Generating Waste Site Cleanu -Dail Operations ENTAL <br /> B,Haza ou Propertre; t��A �t.t°1�osorr+�c+r" <br /> 1.U.S.EPAHa2ardous Waelo? ®Yes DNo 2. State Cade(a): 331 _ <br /> EPA Coda(s): D001 <br /> e,Is Wasto Product: 08hock Sensitive Q Reactive DRndloacilve ❑Pyrophorfo DEliological Z None <br /> C.Phyaical Properties at 70°F. _ <br /> 1.Physical Slate: 2,Layers 3.Flesh Point(Closed Cup Only): 4.Viscosity similar to: <br /> [3 solid 1]Sludge D Mullilayared ❑c70°F [1140-200°F ❑Water <br /> V1 Liquid []Empty Container D sl-Layored 0 70.100°F []No Flash ❑Motor Oil <br /> El Aerosol 0Homogenous 17101-139°F El Exact ❑Honey <br /> Any free liquids at 70°F 0 other <br /> — <br /> 0 Yes M No <br /> D. 1.Density 2.%Solids S.Odor 4.Ph, <br /> Liquid� Iba/gallon 0 By Weight ❑None fje2 09.1-12.5 <br /> Solid ❑_._ lbs/cublcfL El By Volume CIStrong 02-5 ❑ 12.6 <br /> e- Any debris In waste: Total ❑Mild ❑5.1-9 ❑Exact_ <br /> 171 Yes 0 No Describe: <br /> Explain <br /> (>7rltele NONE NONE <br /> @. Chemical Composition(Account for 100%of total): panne Total(PPM) Pesticides,Herbleldas:PPM <br /> Adhesive —_— 100 — 100 °k M_p Toxlolty(mgll) Endrin. . . . . _ <br /> % Arsenic(As) Undane. . . . . <br /> MSDS SHEETS ATTACH9D — --% Barium(Be) Melhoxychlor _.— <br /> % Cadmium(Cd) Toxaphene <br /> Chromium(Cr) 2,4-P <br /> % Copper(Cu) 2,4,5•YP <br /> Lead(Pb) Other <br /> Mercury(Hg) <br /> Nickel(Ni) Resolves&other <br /> ------ Wastes(PPM): <br /> % Selenium(Se) <br /> ?/° silver(Ag) ..._ Cyanides—Dioxin <br /> i° Zinc(Zn) Suiffdes___PCBs„_ <br /> F shipping and Handling Information: HOC Phenols <br /> 1.D.0, Hazardous Matetial7,J�-YesZINO <br /> ,.2.Proper D.O.T.Shipping Name: UNI 133,Waste Adhesives [containing a flammable Iiuuid], _ <br /> S.D.O.T.Hazard Class: 3, _ 4.D.O.T.ID Number.UN1133 _PG: PGII _ <br /> S.Method of Shipment:___ Drum and/or---_Bulk___._Other 6.O.O.T.Shipping Container. 554 drums (GI A Qt cont) <br /> 7.Prolecled Volume: Tons Gallons Cubic Yards Olher 8.RQ Amount—_ <br /> Per_1-104 One Time Week Menih_ _._.Quartar x Year <br /> Comments: <br /> GENERATOR CERTIFICATION STATEMENT <br /> I 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 andlaccurale.Analysis of the waste was conducted in accordance with[be approved lesl methods In 40 CFR 261 on a ropresentalive sample <br /> dokned In 40 CFR 261.20.To the best of my knowledge, dff known(40 CFR 261)and suspected hazardous components have been included in <br /> this docur nply wllh all current regulaffons. <br /> signature_ n J{ 1� — •----Tills Date _02/19/16 <br /> FORM4 <br /> W�( FORM 402(Ro¢03/f0)~ <br />