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Crosby & Overton, Is. Internal Use Only <br /> Waste Product Questionnaire Job Number 59363 <br /> General Information <br /> ^snerator Name Valero Billing Name DECON Environmental Services,Inc. <br /> .dress 2941 Navy Drive Address 23490 Connecticut Street <br /> City,State,Zip Stockton,Callforria 95206 City,State,Zip Hayward,California 94545 <br /> Contact Mr.Von Crites Contact Mr.Jason M.Costello <br /> Phone (209)943-5662 Fax Phone (510)732-6444 Ext,20 Fax (510)782-8584 <br /> EPA Number CAT000617514 <br /> WASTE PRODUCT DESCRIPTION AND CHARACTERISTICS <br /> Waste Product Common Name Waste Gasoline and Trace Water with Combustible Red Dye Additive <br /> Process Generating Waste Waste Gasoline from onsite QA QC Testing <br /> A. Hazardous U.S.EPA Hazardous Waste? Yes © No ❑ <br /> Properties: State Code(s)321 EPA Code(s) D001,D018 <br /> Waste Product: Shock n Sensitive n Reactive n Radioactive rJ Pyrophodc ❑ Etiological n None <br /> B.Physical Phys.State: Solid ❑ Liquid © Any Free Liquids at 70 F? Yes ® No ❑ <br /> Properties at 70 F Sludge ❑ Empty Container ❑ <br /> Layers: Multilayered ❑ Flash Point <70 F ❑70-100 F 0101-139F <br /> Bi-Layered ❑ (Closed Cup Only) 140-200 F ❑No Flash ❑Exact <br /> Homogenous <br /> Viscosity Water © Honey ❑ <br /> Motar Oil ❑ Other ❑ <br /> C.Density: Liquid Lyi Ins./gallon %Solids By Weight Ph <2 ❑ 9.1-12.5 <br /> Solid El lbs./cubic ft. 0-0.1% By Volume 5-Feb ❑ >12.5 Q <br /> Odor. None 5.1-9 © Exact ❑ <br /> Any debris in waste: Yes ❑ Strong <br /> No Q Mild <br /> Explain: Describe: Gasoline Odor <br /> i <br /> D.Chemical Composition(account for 100%of total) Range Metals: Pesticides.Herbicides•PPM <br /> % Total(PPM) Endrin N/A <br /> e/n EP Toxicity(mg/1) Lindane N/A <br /> Waste Gasoline 0.0-100 % Arsenic(As) NIA Methoxychior N/A <br /> Water .0-5.0 % Badum(Ba) WA Toxaphene N/A <br /> Red Dye Additive .0-5.0 o/u Cadmium(Cd) N/A 2,4-D N/A <br /> % Copper(CU) N/A 2, 4,5-TP WA <br /> % Lead(Pb) <1.0% Other WA <br /> % Mercury(Hg) NIA Reactives/Other Wastes IPPMI: <br /> e/n Nickel(Ni) NIA Cyanides N/A <br /> 7/6 Selenium(Se) N/A Sulfides NIA <br /> % Silver(Ag) WA HOC N/A <br /> °/a Zinc(Zn) NIA Dioxin WA <br /> PCBs N/A <br /> E.Shipping and Handling Information Phenols NIA <br /> D.O.T.Hazardous Material: Yes © No ❑ <br /> Pr pgr n n T-Rhipping Warrip WAgte r:acnl'nc �LOS.kla7ard r'laac' 3 <br /> D.O.T.ID Number&PG UN1203/PGII Method of Shipment 1 x 55-gallon 1A1 Drum amd/or Drum <br /> Bulk: Est.4,000 gal Other: D.O.T.Shiping Cm- 1 x 55-gallon 1A1 Projected Volume <br /> Tons: Gallons: Est 55-gal Cubic Yards: Other: <br /> RO Amount Per One Time X Week <br /> Month Quarter Year Comments <br /> - Generator certicication Statement <br /> I hereby certify that as an authorized representative of the generator named above,all information submided in this and all me attached documents is true andfaccurate. Analysis of the waste was conducted in <br />__. accordance with the approved test methods In 40 CFR 261 on a representative sample as defined in 40 CFR 261,20. To the best of my knoMedge,all knovm(40 CFR 261)and suspected hazardous componems <br /> have been included in this documental All material and packaging wi11 comply with all cunent regulations. <br /> Signature Title: Date: <br />