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UL-LD- 10 10: 14 rKUlrl- toles tnvlronmentai -ilii1-440 V0002/0002 1--819 <br /> Crosby &0,11"' Vertonjug Internal Use only <br /> Job Number: <br /> 1. <br /> WASTE PRODUCT QUESTIONNAIRE <br /> CGNIPRALINFOIRMATTON FAX (562)495-2181 96571 <br /> ConorntorNmemPacifcSouthwest Irrigation ¢IIII,IgNameCOLESENVIRONMENTAL <br /> Addrosa_37t?• 2 S 4I@ck Tone Road _ Address PO BOX 10764 <br /> City,Smtr:,ztp_�1 'Mv PC e y� ggR�yF'(ELD,CALIF 9z <br /> Contact Colin e V .1 Orge OwrV) Cmmomy. ato,MA �1 <br /> hltonc 014/04b-6131.1 Pnx 2091578-0142 Comacl MARY MILLER —� J <br /> EPAPhone 661/322-8258 Pnx 661/3k- <br /> II. �uniber gAL6003-5887�7II.WASTE PRODUCT DESCRIPTION&CHARACTERISTICS APR 0 S 2015 <br /> A.Waste Product Common Name Adhesive(Weldon-On Products) _ <br /> 1.ProcovsGenerating Waste Site Cleanup-Daily Operations TAL <br /> 6.Ha25r ou., roper-es. _ )Jr'4,TrJ r, 7T!t"!E!vT <br /> 1.U.S.EPA Hazardous Waste? ®Yes ❑No 2 State Coda(s): 331 <br /> EPA code(s): D001 ... <br /> e.Is Waste Product: OShocic Sensitive 11 Reactive O Radioactive ❑Pymphorlc O Ellological Q✓ None <br /> C.Physical Properties of 700 F: <br /> 1.Physical state: 2.Layers S.Flesh Point(Closed Cup Only): 4.Viscosity similar to: <br /> ❑Solid (]Sludge ❑Mullilayared ❑K700 F 11140-2000 F ❑Water <br /> 0 liquid []Empty Container ❑BI-Layored 070-100'F ❑No Flash ❑Motor Oil <br /> O Aerosol m Homogenous 0101-1390F ❑Exacl— []Honey <br /> Any free liquids at 700 F 0 Olhor <br /> ❑Yes I7 No <br /> D. 1.Density 2,%Sogds 3.Odor 4.Ph, <br /> liquid 2L Iba/gallon 0 By Weighl ❑None 11<2 ❑9.1-12.5 <br /> Solid 13_._ lbs/cublc ft. 11 By Volume (]Strong 02-5 O>12.6 <br /> - Any debris in waste: Total El Mild 13 SA-9 0Exact� .� <br /> La Yes 0 No Describe: <br /> B]Plsin <br /> Main'a NONE NONE <br /> E. Chemical Composition(Account for 100%of total): Range Total(PPM) Peslicides,Herbicides:PPM <br /> Adhesive 100 - 100 -A —EP Tox!city(mgll) Gndfin. . . . . _ <br /> Arsenic(As) Undone. . . . . <br /> MSDS SHEETS ATTACHES - % Barium(Ba) Melhoxychlor --, <br /> cadmium(Cd) Toxaphene <br /> --• -' % Chromium(Cr) <br /> .�.. % Copper(Cu) 2,4,s•TP <br /> % Lead(Pb) Other <br /> % Mercury(Hg) <br /> % Nickel(Ni) Reectives&Other <br /> % Selenium(Be) Wastes(PPM). <br /> % Silver(Ag) — Cyanides_Dioxin <br /> % Zinc(Zn) SulffdosL__PCBs <br /> F shipping and Handling Information: t--1'' HOC PhenolB <br /> 1.D.01 Hazardous Material7rn�,Yea,�JJo <br /> ..2.Propsr D.O.T.Shipping Name: UN 1133, Waste Adhesives, fcontaining a flammable liautdl <br /> S.D.O.T.Hazard Class: 3, 4.D.O.T.ID Number:UN1133 _______PG: PGII _ <br /> 5.Method of Shipment:___ Drum and/or__._Bulk___.,_Other 6.D,O.T.Shipping Container, 65-ql drums (GI &Qt cont) <br /> 7.Projecled.Volume: Tons Gallons Cubic Yards lher 8.RQ Amount_- <br /> Per-1 tO 4 One Time Week Month—______Quarter X Year <br /> Comments: <br /> III.GENERATOR CERTIFICATION STATEMENT <br /> I hereby certify that as an authorized representable of the generator named above,all information submi)led in this and all attached documents j <br /> is tree andlaccurate.Analysis of the waste was conducted in accordance with the approved test methods In 40 CFR 261 on a representative sample �..� <br /> donned In 40 CFR 261.20.To the best of my knowledge, all(mown (40 CFR 261)and suspected hazardous components have been Included in <br /> this docm' mply with all current regulations. <br /> Signalure— ,� <br /> (A�LL✓r► J i- N/t/ FORM 102(Rev.03/10) <br />