Laserfiche WebLink
57-11 <br /> 50 <br /> Crosby and Overton, Inc. WASTE PRODUCT QUESTIONAIRE 35321 <br /> I. GENERAL INFORMATION <br /> venerator Name: VALERO Billing Name: MESA ENVIRONMENTAL I <br /> .,ddress: 2941 NAW DR. Address: 1444 E.BURNETT ST <br /> City,State,Zip STOCKTON CA 95206 City,Stale,Zip SIGNAL HILL CA 90755 <br /> Contact Contact <br /> Phone: Phone: 562424-4510 <br /> Fax: Fax: 562-424-3067 <br /> EPA Number. CAT000617514 Expiration Date: 7/25/2007 <br /> II.WASTE PRODUCT DESCRIPTION&CHARACTERISTICS <br /> A. Waste Product Common Name: FOAM LOG AND PPE <br /> Process Generating Waste: TANK CLEANING <br /> B. Hazardous Properties: State Code(s) EPA Code(s) <br /> 1. US EPA Hazardous Waste? ❑ Yes Z No 2 352 <br /> 3. Is Waste Product: ❑Shock Sensitive ❑ Reactive ❑ Radioactive ❑ Pyrophoric ❑EOological Q None <br /> C. Physical Properties at 70 deg F: 2. Layers 3. Flash Point(Closed Cup Only) 4. Viscosity,similarto: <br /> 1. Physical State: ❑ <70 deg F ❑ Water <br /> O Solid ❑Aerosol ❑ Mulfil-ayered ❑ 70-100 deg F <br /> ❑ Liguid E] Lab Pack © Bi-Layered ❑ 101-139 degF ❑ Motor Oil <br /> ❑ Sludge 11Free Liquids E] Homogenous ❑ 140-200 deg F E] Honey <br /> Gas <br /> ❑ Empty Container ❑ Any Free Liquids @ 70 0 No Flash 0 Other SOLID <br /> ❑ ny F L] Exact WA <br /> D. 1. Density: 4. Ph. <br /> Liquid ❑ 0 lbs/gallon 2. %Solids 3. Odor. [j NIA <br /> Solid: 0 Ibs/cubicft. Q By Weight ❑ None []<2❑ ❑ By Volume ❑ Strong 2 5 <br /> Any_debrisinLwaste� Totat_0 __Z. Mild _ <br /> Yes ,�No Describe: - -- ❑5A--9 - - -- <br /> ❑ ❑ ❑9.1-12.5 <br /> Explain: >12.5 <br /> BExact 5.00 <br /> E. Chemical Composition(Account for 100%of total) Range Metals TTLC: Copper. <br /> r....__...-.i <br /> FOAM LOGS-RUBBER FOAM TO INSULATE 198 — :100 % -i Total(PPM) Lead: ;45-- --- <br /> t2......_.+ % — EP Toxicity(mg/I) Mercury: i <br /> PPE i — ..... ......... <br /> i.............! <br /> }-.-.......; — ..........., Antimony: : ; Nickel: <br /> I <br /> ._...___� !.............! <br /> ---------- ---------- Arsenic: 1Nb 1 Selenium: <br /> — . <br /> Barium: 152.53 Silver. :ND : <br /> r.........., r.........., <br /> i...._._--...y r..........._y <br /> : : Beryllium: :ND Zinc ;102.15 1 <br /> I.............4 !...----------! <br /> Cadmium: :NO 1 Molybdenum <br /> — Chromium: :9.02 Thallium: <br /> — Cobalt :1.69 Vandium: <br /> Reactives,8 Other Pesticides,Herbicides: 1 ! <br /> : 1 <br /> t..........! !...... Wastes(PPM): nn.. <br /> _ Endrin:------------- <br /> 1 <br /> .........._. i........--i Cyanides: <br /> 1 i.............t <br /> — 1 1 <br /> ............... Lindane ;....---------; <br /> ..........i i-.-.--.--.! Dioxin: Methoxychlor: : <br /> Sulfides: 1 t-------------t <br /> (......_.._t !._.__.....) i.............i Toxaphene: : <br /> PCBs: �.............! <br /> - i........._. i..........! P24D: <br /> : — HOG: I............. P245TP: .............. <br /> e..........i i......._..n i.............{ : <br /> Phenols: r i'-----------i <br /> 1. D.O.T. Hazardous Material? ❑ Yes[;;I No 2. D.O.T Shipping Name: Non-RCRA Hazardous Waste Solid <br /> 3. D.O.T.Hazard Class: 4. D.O.T. ID Number. NIR Solid Packing Group <br /> 5. Method of Shipment: O Drum ❑Bulk ❑Other 6. D.O.T.Shipping Container: DOT <br /> 7. Projected Volume: 0 Tons: 0 Galllons 0 Cubic Yards 0 Other 6. RQ Amount 0 Per ! <br /> Comments <br /> -ENERATOR CERTIFICATION STATEMENT: I hereby certify that as an authorized representative of the generator named above,all Information submitted in this and all the <br /> ached documents is true and accurate.Analysis of the waste was conducted in accordance with the approved test methods In 40 CFR 261 an a representative sample as <br /> .efined in 40 CFR 261.20.To the best of my knowledge,all known(40 CFR 26 1)and suspected hazardous components have been Included in this documentation.All material and <br /> packaging will comply with all current regulations. <br /> Generators Authorized Signature: Title Date <br />