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02-25-'15 15:14 FROM- Coles Environmental 661-322-8883 • T-440 P0002/0002 F-919 <br /> rob , neon, �nc6 <br /> • , k • Internal Use Only <br /> Job Number: ' <br /> WASTE PRODUCT QUESTIONNAIRE <br /> 1,OMMALINFOYt11ATY011 - FAX (562)495-2181 96571 <br /> CeneratorNnmePaclficSouthwest Irrigation Billing NameCOLESENVIRONMENTAL <br /> Addreaa_372 S flack Tone Road <br /> City,State,Zip �6�y� CA 95215 - Address PO BOX 10764 _ <br /> Contact Colin Kelly(f;eorge owrv) City,Slate,zip BAREk-SFCELD, CALIF 93389 / 1 r— <br /> Phone -8 0 rax 209/578-0142 Contact MARY MILLER —_ r�VES <br /> EPA NumberCAL000358877 Phone 661/322-8258 pox 661/322-8883 IV <br /> ED <br /> WASTFPRODUCT D58CRIPTION&CHARACTERISTICS APR 08 2015 <br /> A,Waste Product Common Nam Adhesive(Weldon-On Products <br /> 1.Process Generating Waste Site Cleanup-Daily Operations -All..j ION <br /> B,He ave roper ea: - MEN NAL <br /> 1.U.S.SPAHazordous Waste? ®Yes ❑No 2. State Cade(s): 331 <br /> EPA Code(s): D001 <br /> c,Is Waste Product: 17Shocit Sensliive - Q Reactive ❑Radloactive ❑Pyrophorlc ❑Etiological Q Nona <br /> C.Physical Properties at 700 F; <br /> 1.Physical State: 2.Layers 3.Flesh Point(Closed Cup Only): 4.viscosity similar to: <br /> ❑Solid l]Sludge ❑Muliilayared ❑<700 F 0140-200-F ❑Water <br /> W Llquld []Empty Container ❑BI-Layered ❑70-100°F ElNo Flash ❑Motor Oil <br /> ❑Aerosol 0 Homogenous 0101-1390F ❑Exact„ Money <br /> Any free liquids at 70°F 0 Other <br /> ❑Yes ❑No <br /> D. 1.Density 2.%Solids a.Odor 4.Ph. <br /> Liquid VI Ibs/gallon ®By Weight ❑None ❑<2 139.1-12.5 <br /> Solid ❑_._ Ibs/cubicit. El By volume []Strong 02-5 17>12.5 <br /> Any debris in waste: Total ❑Mild Ib 5.1-9 0Exacl_ <br /> tg Yes PI No Describe: <br /> Explain <br /> NONE <br /> E. Chemical Composition(Account for 100%oflolal): Amiga IRbtda NONE 701al(PPM) Pesuc does,Herblcldes:PPM <br /> Adhesive 100 — 100 <br /> @P Texlohy(mgB) Endrin. . . . . <br /> Arsenic(As) Undone. . . , . <br /> MSDS SHEETS ATTACHEg — % Barium(ea) Methoxychlor _ <br /> Cadmium(Cd) Toxaphene <br /> --• — % Chromium(or) 2,4-P <br /> % Copper(Cu) 2,4,5.7P <br /> _% Lead(Pb) Other. <br /> % Mercury(Hg) <br /> % Nlekel(Ni) Reactive&&Other <br /> -- — % Selenium(Be) Wastes(PPM): <br /> % Silver(AU) _ Cyanides—Dioxin <br /> i, Zlnc(Zn) SullldosL—_PCBs-._ <br /> F shipping and Handling Information: I--t"' HOC Phenols <br /> 1.-D.O.T.Hazardous Mateiial7-aYea,OJJo <br /> ..2.Proper D.O.T.Shipping Name: ON 1133. Waste Adhesives, (containing a flammable li0uidl <br /> S.D.O.T.Hazard Class: 3, 4.D.O.T.ID Number:LIN1133 _PG., PGII _ <br /> 5.Method of Shipment:___ Drum and/¢r__-_Bulk___.,.,Olhor 6.b•O.T Shipping Comalner'55-g1 drums (GI&Qt cont) <br /> 7.Pro)eoled Volume: Tons Gallons Cubic Yards Olher 8.RQAmount__ <br /> Per—�t0 4 One Time—Weak Month—_Quartor x Peer <br /> Comments: I- _ <br /> �)III.GENERATOR CERTIFICATION STATEMENT <br /> I hereby certify that as an authorized representative of the generator named above,all information submitted in this and all attached documents <br /> to true and/accurate.Analysis of the waste was conducted in accordance with the approved test methods In 40 CFR 261 on a representative sample <br /> defined In 40 CFR 261.20.To the best of my knowledge, all known(40 CFR 261) and auepecied hazardous components have boon Included in <br /> this docur, nply with ail current regulations. . <br /> signalure— ,�/,,, __—,- —Tills —y_ ^ <br /> (A/�!✓d FORM 402(floe.03/10)~ <br />