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CROSBY&OVERTORNC. PROFILE# <br /> PH:(562)432,5445 <br /> WASTE PRODUCT QUESTIONNAIRE FAX:(562)495.2181 <br /> GENERAL INFORMATION <br /> Generator Name: Universal Service Recycling Inc Billing Name: McDougall Environment <br /> Site Address: 3200 S EI Dorado St Address: PO Box 450 <br /> City I State f Zip: Stockton,CA 95206 City i State(Zip: Georgetown,CA 95634 <br /> Contact: Steven Slater Contact: Sean McDougall <br /> Phone: 209-751-9946 Fax: Phone: (530)3334684 Fax: <br /> EFA ID Number: CAL000355717 <br /> WASTE PRODUCT DESCRIPTION AND CHARACTERISTICS <br /> Waste Product Common Name. Adhesives <br /> Generating Waste Process Surplus aged or off-specifieatlon products unused commodity pack <br /> A.Hazardous Properties B.Physical Properties ­­­ <br /> U.S.EPA Hazardous Waste? OYes No Physical State: Solid 0 Liquid 0 Sludge Aerosol Empty Container <br /> State Codes) Any free liquids at 70°F: a Yes No Color: Dark brown/black/gray <br /> 331 Layers: Multi-Layered Flash Point i<70°F 70-100°F 101-134°F <br /> EPA Code(s) Bi-Layered (Closed Cup Only) 140-200°F No Flash @Exact 4F <br /> 0001 <br /> Waste Product: 0 Homogenous <br /> Shock Sensitive Reactive Radioactive Viscosity: Water +Honey Motor Oil @ Other viscous liquid to pasta <br /> Pyrophoric Etiological ®None <br /> C.Density D.Misc.Regulatory <br /> Liquid 9,6 lbs/gallon %Solids: GByWelght 15-35 By Volume Source Code: G11 <br /> Solid — lbs/cubic ft. pH: <2 2-5 05.1-9 Form Code: W210 <br /> Any debris in waste? e Yes No 4.1-12.5 >12.5 6 Exact NIA <br /> Odor: None 0 Mild Strong L.A.Country Sanitation District Category: <br /> Explain: Product containers(cans) Describe:solvent/Matto Oil Organics <br /> E.Chemical Composition(account for 100%of total) RANGE METALS PESTICIDES/HERBICIDES(PPM) <br /> Aromatic oil 30- 60 % Total(PPM) x Endrin none <br /> Mineral spirits 1- 10 % EP Toxicity(mg/1) Lindane none <br /> Ethyl acetate 4- 10 % Arsenic(As) < 5 Methoxychlor none <br /> Petroleum asphalt 10- 40 % Barium(Ba) <100 Toxaphene none <br /> Tetrahydrofuran 5- 15 % Cadmium(Cd) < 1 2,4-0 none <br /> Methyl ethyl ketone 5- 7 % Chrome(Cr) < 5 2,4,5-TP none <br /> Cyclohexanone 1- 3 % Copper(Cu) < 25 Other none <br /> Acetone 1- 2 % Lead(Pb) < 5 REACTIVES/OTHER WASTES(PPM) <br /> Calcium carbonate 1- 2 % Mercury(Hg) < 0.2 Cyanides none <br /> Carbon black 6- 12 % Nickel(Ni) < 20 Sulfides none <br /> Hydrotreated heavy naphthenic distillates 0.4- 1 % Selenium($e) < 1 Halides none <br /> Tosyl Isocyanate, 0.1- 1 % Silver(Ag) < 5 Dioxin none <br /> 2,4-toluene diisocyanate 0.1- 1 % Zinc(Zn) 10,000PCBs none <br /> F.Shipping and Handling Information <br /> Phenols_none <br /> D.O.T.Hazardous Material: 0 Yes No <br /> D.O.T.ID Number: UN1133 Proper Shipping Name: Waste Adhesives <br /> D.O.T.Hazard Class: 3 PG: ii <br /> Method of Shipment: 55-gal Drum: — Bulk: Other: <br /> D.O.T.Shipping Container: UN drums Projected Volume: 1-2/yr Gallons: Cubic Yards: R4 Amount: 100 lbs <br /> COMMENTS:Unused products are packed in thelr original containers,placed Ina drum,MSDS attached: Tremproof=5 ga11 Henry=2 x 1-galf Weld-On=I gal <br /> Generator Certification Statement <br /> I hereby certify that as an authorized representative of the generator named above,all information submitted in this and all the attached documents is true and accurate, <br /> Analysis of the waste was conducted in 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 <br /> knowledge,all knov:n(40 CFR 261)and suspected hazardous components have been Included in this documentation. All material and packaging will comply with all <br /> current regulations. <br /> Signature: Print Name: Sean McDougal} Title: Agent Date.. APR 142020 <br /> (Print,sign and send to customer service) <br />