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FEB-01-2008 FRI 04: 22 PM N• UH <br /> Intemsl Use ®rdy <br /> tar,: Crosby c - � �verton, l c. <br /> Job Number, <br /> WASTE PRODUCT QUESTIONNAIRE <br /> tp✓, C 2 <br /> t. ct trt t:nt <br /> "o0 <br /> !!'' i // <br /> GenerxWr N � H)1IItt�Natme t@1'TVRRSer. RNY�P.OAMt:N7'Ai� <br /> Address qY AbhtVAddress 4707 '�p�q'[giyi. WAV <br /> City,Store. A ty,State P SENICI9. CA. 94'SL0 <br /> C o"Z S TlIY4 STAPiMIR'D <br /> Phone Paz Phoae 707-747-6699 Faz. 7D7-747-1927 <br /> EPA Number <br /> II. WASTE PRODUCT DESCRIPTION&CHAAACTERISI•IC3^�.// �- <br /> A. Waste Product Common Name .( /.- '•N /V!I/o4y' L/LI( y-G}L/ Gl,f-moi <br /> 1. VroCae6 C�narattng Wasto <br /> B. Hazardous PloyurGes: <br /> 1. U.B.EPA Hazardous Waste? 0 Yes P1 0 2- Stata Code(s)- _ <br /> EPA Code(s): <br /> c,Is waste Product: 0 shock sensitive ❑Reactiva 0 Radl02c5vs, 0 Pyrophoric 0 Etiological ❑Nona <br /> c. Physical Properties at Ar P. <br /> 1, state; 2- Layers 3, Ftash'PoInt(Closed Cup Only); a_ tr�lty,Similar lo: <br /> lid ElSludge 0MuRiiayered 0<70"P 0140-20D°F ❑Weber <br /> 0 iiquid 0 Empty Contalner Q IN-layered ❑70-IW F 'Awo Flesh ❑Motor Oil <br /> Any tree liquids at 70°F omogenous 0101.139°F ❑Emct El Honey <br /> ❑Yac ❑No / 0 Other <br /> D. 1. Donwty: 2 90 Solids 3 Odar C Ph <br /> liquid❑ Ibs/gallon yWeight -19 None Oct 09,1-125 <br /> Solid ❑ IWcubictt Volu ❑Strong ❑2-b• 0>125 <br /> Any debris in wasax ow 0 Mild 0 Exact <br /> 0 Yes 0 No Descnbe: <br /> foomp Account r 700a9�'e afMtai); �gitga M�T Total(PPM) Pestdi6es,Herbicides:PPM <br /> Y' l7Y.usr % Endrin, <br /> _EP Tozlciy(mg/t) <br /> - ys Lindane. _ , . . . <br /> Arsenic(As) <br /> I/ _ % atertwxyarloi <br /> A' % Barium (Be) Touaphane <br /> % Cadmlum(Cd) 24.0. <br /> Chromium(Cr) P,4,5-TP <br /> Dopper(Gu) Other <br /> % t.�d(Pb) <br /> % t�erc+uy(H91 Reaclivea&Omar <br /> r•Lokel(W) Wastes(PPM): <br /> % Selenium(Sa) Cyanides _ Dioxin _ <br /> % Silver(Agl Sulfide$ PGBs <br /> Z[no(7') HOC Phnnois <br /> F. Shipping and tiondling Infornta9un: <br /> 1. D.O.T. Hazardous Matonal9_YM No 2- Proper O,D.T. Shipping Name: <br /> 0, D.O.T. Hazard Glias: 4, D.O.T. ID Number. <br /> 5- Method orf ShiprrlbnC Drum and/or Bulk Other (x D.O.T, shipping Cdntairwr <br /> T, projected voiu e: Tons GanOne Gubic Yards Other B. Rq Amoum <br /> Pur One Time Week Month Ouartar Year <br /> Comments: <br /> III. GENERATOR CERTIFICATION STATEMENT <br /> Hereby certify that as an authorized represenreNva of the gansrator named above, all intortnation submitted in this and all the attached documents <br /> Is true and7accurate.Analysis of the waste was conducted In accordance with the approved tern methods In 40 CFR 261 on a mpresenta0va sample <br /> as defined In 40 CF 4329j,To the best of my knowledge,an known (40 CFR 2fl1)and suspected hazardous components have been Included in <br /> fits tl0cumen N n.All t6rlal and packaging will comply with all current reguialiens. <br /> 41 TiYne 52U&L. Date <br />