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02-25-'15 15:14 FROM- C* Env ironmentta1 661-322-8883 , T-440 P0002/0002 F-919 <br /> CA-rujisby ' T Ved® Inco Internal use Only <br /> � Job Number: <br /> WASTE PRODUCT QUESTIONNAIRE <br /> t.OCNi:nALINFORMATrON FAX (562)495-21111 96571 <br /> Generator Name Pacific Southwest Irrigation BnlingName COLES ENVIRONMENTAL <br /> Addresa-372 S 4a-qTone Road Address PO BOX 10764 <br /> City,State,Zip ��� p C 95 <br /> Conmu Colic Kelly( serge owrvl City,State,zip BAR@hFfELD, CALIF 93389 �� <br /> hllone -8 Fnx 2091578.0142 Contact MARY MILLER _ <br /> EPA Number•CAL000358877 Phone 6611 32 2-82 58 Fox 661/322-8883 <br /> II.WASTE PRODUCT DESCRIPTION&CHARACTERISTICS APR 0 S 2015 <br /> A,Waste Product Common Name Adhesive(Weldon-On Products) <br /> 1.ProcsesGenerating Waste SiteCleanup-Daily Operations NTAL <br /> B.Hazardous Properties; HEALTH r)FPARTMFNT <br /> 1.U.S.EPA Hazardous Waala? ®Yes ❑No 2. State Cada(e): 331 <br /> EPA Codo(s): D001 <br /> e,Is Waste Product: 08hock Sensitive (]Reactive ❑Radioactive ❑Pymphorlc ❑Etiological ❑✓ None <br /> C.Physical Properties at 70°F; <br /> 1.Physical State: 2.Layers 3.Flash Point(Closed Cup Only): 4.Viscosity similar to: <br /> ❑Solid 1]Sludge ❑Multilayered ❑<70°F ❑140-200°F ❑Water <br /> [a Mcluld []Empty Container D SI-Layered [170-1 00o F []No Flash O Motor Oil <br /> ❑Aerosol 0 Homogenous ❑101-139°F ❑Exact []Honey <br /> Any free liquids at 70"F 0 other <br /> O Yes ❑No <br /> D. 1.Density 2.%Solids S.Odor 4.Ph. <br /> Liquid El Iba/gallon 0 By Weight ❑Nona 0.2 O 9-1-12.5 <br /> Solid ❑_-_ Ibs/cublc(t. ❑ By volume U Strong ❑2-5 ❑>12.6 <br /> Any debris in waste: Total ❑Mild 115.1-9 ❑Exacl-- <br /> LO Yes &d No Describe: <br /> Explain <br /> Motel NONE NONE <br /> E. Chemical Composition(Account for 100%of total): Range Total(PPM) Peslicidea,Herblcklas:PPM <br /> Adhesive ___ 100 - 100 % NEP Toxicity(moll) Fndrin. . . . . _ <br /> Arsenic(AS) Lindane. . . . . <br /> MSDS SHEETS ATfACHEP- - % Barium(Be) Methoxychlor _.- <br /> 5'> cadmium(Cd) Toxaphene <br /> Chromium(Cr) 2,4-D <br /> - % <br /> Copper(Cu) 2,4.5-TP <br /> Lead(Pb) Other <br /> - /> Mercury(Hg) <br /> -" % Nickel(Ni) Reactive&&Other <br /> Wastes(PPM): <br /> ._. - y, Selenium(Se) <br /> - % Silver(Ag) Cyanides_Dioxin <br /> -- - % Zino(Zn) Sulfldo&.--PCBs <br /> F shipping and Handling Information: � HOC Phenols <br /> 1.D.O.T.Hazardous Matedal?mxes,Q,J�o <br /> .2.Proper D.O.T.Shipping Name: UN 1133 Waste Adhesives, fcontaininq a flammable liauidl. <br /> S.D.O.T.Hazard Class: 3, ,___- 4.D.O.T.ID Number.UN1133 _pG: PGII _ <br /> 5.MalhId of Shipment:___ O(um and/or-_.—Bulk_-__Other 6.O.O.T.Shipping Container. 55-d drums (GI&Qt cont) <br /> 7.Projected volume: Tons Gallons Cubic Yards Other S.RQ Amount <br /> Per_7_to 4 One Tfine _ Wgok Month -._,Quarter x Year <br /> Comments: F- <br /> -Ill.GENERATOR CERTIFICATION STATEMENT <br /> I hereby certify that as an authorized representative of the generator named above,all information submilled in this and all attached documents l <br /> is true andlaccurate.Analysis of the waste was conducted in accordance with the approved test methods In 40 CFR 261 on a representative sample <br /> daftned in 40 CFR 261.20.To the best of my knowledge, all(mown(40 CFR 261) and svepected hazardous components have been Included in <br /> this docur nply with all current regulations. <br /> Signature,- <br /> V1/l _T lie ___Date__02/19/15 <br /> -.-- ---- <br /> FORM 402(Ray.03/10)_ <br />