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Crosby and Overton, <br /> Inc. WASTE PRODUCT QUESTIONAIRE 53014 <br /> I. GENERAL INFORMATION <br /> Generator Name: ST SERVICES LLC Billing Name: UNIVERSAL ENVIRONMENTAL.INC. <br /> ddress: 2941 NAVY DRIVE Address: 4101 INDUSTRIAL WAY <br /> City,State,Zip STOCKTON CA 95206 City,State,Zip BENICIA CA 94510 <br /> Contact: BILL Contact: <br /> Phone: 209-943-5662 Phone: 7077476699 <br /> Fax: 209-943-0908 Fax: 7077471927 <br /> FPA Number. CATQQQ617514 Exnlmtion Date: 1/3012009 <br /> II.WASTE PRODUCT DESCRIPTION&CHARACTERISTICS <br /> A. Waste Product Common Name: ABSORBENT.PPE AND DEBRIS WITH GAS AND DIESEL <br /> Process Generating Waste: AREA CLEAN UP <br /> B. Hazardous Properties: State Codes) EPA Code(s) <br /> 1. US EPA Hazardous Waste? ❑ Yes Q No 2 352 <br /> 3. Is Waste Product: ❑Shock Sensitive ❑ Reactive ❑ Radioactive ❑ Pyrophoric []Etiological 0 None <br /> C. Physical Properties at 70 deg F: 2. Layers 3. Flash Point(Closed Cup Only) 4. Viscosity,similar to: <br /> 1. Physical State: ❑❑ Mu1 <70 deg F ❑ Water <br /> ❑✓ Solid ❑ Aerosol 0Layered 70-100 deg F <br /> ❑ Liguld ❑ Lab Pack O Bi-LayeredO 101.139 deg F E] Mctor Oil <br /> ❑ Sludge ❑ Free Liquids ❑ Homogenous ❑ 140-200 deg F ❑ Honey <br /> ❑ Empty Container ❑ Any Free Liquids @ 70 ExactNo a N/A ❑✓sh Other SOLID <br /> D. 1. Density: ❑ Deg F ❑ <br /> 4. Ph. <br /> Liquid ❑ 0 lbs/gallon 2. %Solids 3. Odor. N/A <br /> Solid: ,� 60 lbs/orbic ft. E] By Weight ❑ None ❑❑El By Volume EI Strong o2-5 <br /> Any debris in waste: Total: 100 ❑./ Miid ❑ <br /> ❑ Yes F-11 No —_ Describe: 05.1-9 <br /> ❑9.1-12.5 <br /> Explain: >12.5 <br /> -- - eExact 6.00 <br /> E. Chemical Composition(Account for 100%of total) Range Metals TTLC: Copper. ;120.61 <br /> r_3 ___� rF______{ <br /> DIESEL �0 - , , % i H______ Total(PPM) Lead: F6.01....I <br /> r----H _ F-----I , EP Toxicity(mgfl) Mercury: <br /> GASOLINE '0 ' '2 _ ' -- ' r------� x--- <br /> H --i -, H700 --, % Antimony: , Nickel: 12.98 <br /> PPE,ABSORBENT,DIAPERSAND TRASHr------i r------t <br /> w----a ,.----, Arsenic: HND____f Selenium: HND____{ <br /> Barium: 24.9 , Sliver: ,ND <br /> Beryllium: 'ND -i Zinc x349.17 <br /> h----H r-----1 Cadmium: HND____{ Molybdenum F------1 <br /> - , Chromium: ,4.68 , Thallium: <br /> Cobalt ,1.55 , VandlUm:Reacti <br /> ves,8 Other Pesticides,Herbicides: <br /> rWaste <br /> r----y <br /> -----I Wastes(PPM): Endrin: i------ <br /> Cyanides: <br /> - , Lindane <br /> H------i <br /> r-----I t-----I Dioxin: Methoxychlor. r , <br /> h----7 t-----I Sulfides: , Toxaphene: x -t <br /> PCBs: r______f , <br /> , , P240: F______1 <br /> - , t------1 H------i <br /> HOC: P245TP: , <br /> F. Shipping and Handling Information: Phenols' L_-----, POther: Y -1 <br /> , <br /> No Snipping <br /> 3. D.O.T.Hazard Class: 4. D.O.T. ID Number: NIR Solid Packing Group <br /> 5. Method of Shipment Q Drum ❑Bulk ❑Other 6. D.O.T.Shipping Container: DOT <br /> 7. Projected Volume: 0 Tons: 0 Galllons 0 Cubic Yards 0 Other S. RQ Amount 0 Per <br /> Comments: ra/MI <br /> GENERATOR CERTIFICATION STATEMENT: I hereby certify that as an authorized representative of the generator named above,all information submitted in this and all the <br /> 'ttached documents is true and accurate.Analysis of the waste was conducted In accordance with the approved test methods in 40 CFR 261 on a representative sample as <br /> fined in 40 CFR 26120.To the best of my knnwledge,all known(40 CFR 261)and suspected hazardous components have been Included in this documentation.All material and <br /> ackaging will comply with all current regulations. <br /> Generator's Authorized Signature: Title Date <br />