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i Crosby & Q e 1 I®�� ��ce Internal Use Only <br /> J4 6 A <br /> Job Number: <br /> ( i WASTE PRODUCT QUESTIONNAIRE 96572 <br /> 1,GENERAIANFORMA97ON FAX(662) 495.2181 <br /> GencratorNnmePacifiC Southwest Irrigation BIIIinfiNamo COLES ENVIRONMENTAL <br /> Address 8372 S. Jack Tone Road Address PC) BOX 10764 <br /> Ci[y,State,Zipt{trktnn. (:A q5-5 5 RE1 `FI LD, CALIF 93389 <br /> Concoct Colin Kelly(Georoe Lowrv- --`- sty,surto,Zip <br /> Phone Contact <br /> rax 209/578-0142 Contact MARY MILLER <br /> EPA NumberaL000358877 phone 661/322-8258 rax 661/3 8 <br /> (f.WASTE PRODUCT DESCRIPTION&CHARACTERISTICS <br /> A.Waste Product Common Name Weldon-On Primer P-70 <br /> 1.Proeass Gonerating Waste Site Cleanup-DaIIV Operations <br /> B,HaXar ou PPropartlea: - p.� <br /> 1.U.S.EPA Hazardous Waste? ®Yes ❑No 2. State Coda(a): 7__IZN V V L <br /> EPA Cade(s): D001 <br /> c.Is Waste Product: []Shock sensitive O Reactive O Radioactive Q Pymphorlo D Eliotogical' "70VUrVFNT <br /> C.Physical Properties at 70°F: <br /> 1,Physical State: 2.Layers S.Flash Point(Closed Cup Only): 4.Visionally similar to: <br /> ❑Solid ❑Sludge ❑Multilayered 13.700 F 0140.200°F 0 Water <br /> I�Llquttl []Empty Container ❑ SI-Layered ❑70-100°K OND Flesh ❑Motor Oil <br /> ❑Aerosol 0Homogenous ❑101-139°F ❑Exact_ ®Honey <br /> Anytrea liqulds at 70°F 0 Other <br /> Q Yea ❑No <br /> D. 1.Density 2.%Solids 3.Odor 4.Ph. <br /> Uquld 0__ lbs/gallon ®By Weight ❑None 11<2 ❑9.1-12.5 <br /> Solid � Iba/cublc h. ❑ Byvolume ❑Strong 02.5 D>12.6 <br /> Any debris in waste: Total ❑Mild 05.1-9 13 Exact <br /> U Yes ®No 0esctlbo: <br /> Explain <br /> INONE NONE <br /> E. Chemical Composition(Account for 100%of total): )Bangs Total(PPM) Pesticides,Herbicides:PPM <br /> Primer 100 - 100 % EP Toxicity(mgl8 Enddn. . . . . <br /> Arsenic(As) Lindens. . . . . <br /> �S�SLSHEETS ATTACHED —_--% Barium(Be) Motnoxychlor <br /> -- % Cadmium(Cd) Toxaphene <br /> —• -- % Chromium(Cr) 2,4.0 <br /> .�--_-. - % Copper(Cu) 2,4,5•TP -- <br /> % Lead(Pb) Other <br /> % Mercury(Hg) <br /> % Nickel(Ni) Reactives 8 Other <br /> % Selenium(Ss) Wastes(PPM): <br /> % Silver(Ag) _ Cyanides_Dioxin <br /> % Zinc(Zn) Sulfides_._.....4 PCBs_ <br /> P. Shipping and Handling Information: HOC_Phanols,__ <br /> 1.O.O.T.Hazardous Materiai?MYes nNo <br /> 2.Proper D.O.T.shipping Name: Waste Flammable liquid, n.o.s. (Acetone,Tetrahydrofuran), <br /> S.D.O.T.Hazard Class: 3, 4.D.O.T.ID Number UN1993 _—pa: <br /> 5.Method of Shipment:,,-_.__ rum and/or_-__Bulk--,_Other 6.D.O.T.Shipping Conlalner 55.91 drums GI/Qt Cans)-. <br /> 7.Projected Volume:—___Tana__.___,•_.Gallons Cubic Yards_--Other 8.RQ Amount------ _ <br /> Per 1 to 4 One Time Week _ Month Quarter X" Year <br /> t Comments: 1 <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 /> -� Is true andlacourate.Analysis of the waste was conducted h1 accordance with the approved test methods In 40 CPR 261 on a representative sample <br /> defined in 40 OFF 261.20. To the beat of my knowledge,all known(40 CFR 201) and Suspected hazardous components have been Included In <br /> this occur Tlply with all current regulations. <br /> Signature__ -welt ` _ _ Title y Date02119/15 <br /> (,f/4L f FORM 402(Rev.D3n0) <br />