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CROSBUOYERTON.,HC PR®FILE#-/157-F <br /> PH:(562)432.5445 <br /> WASTE PRODUCT QUESTIONNAIRE FAX:(562)495.2787 <br /> GENERAL INFORMATION <br /> Generator Name: Universal Service ReaXing Inc Billing None: McDougall Environment <br /> Site Address: 3200 S Ei Dorado St Address: AO Box 450 <br /> City I State I Z!p: Stockton,CA 95206 City i State l Zip: Georgetown,CA 95634 <br /> Contact: Stevan Slater Contact Sean McDougall <br /> Phone: 209-751-9946 Fax: Phone: (530)333-46" Fax; <br /> FPA iD Number. CAL000355717 <br /> i <br /> WASTE PRODUCT DESCRIPTION AND HARACTERISf1CS <br /> Waste Product Common Name � illt Orhir-k a-,' tl ririttr3r <br /> Generating Waste Process SU i aaed. off-spedficaton Or mixed oroducts -- <br /> A.Hazardous Properties S.Physical Properties <br /> U.S.EPA Hazardous Waste? #Yes No Physical State: Solid ®Liquid *Sludge Aerosol Empty Container <br /> Any free liquids at 70'F: a Yes No Color Amber to dark <br /> State Codes) <br /> 331 Layers: Multi-Layered Flesh Poin 0<70°F 70-1001 101-139°F <br /> EPA Ccxiets) Bi-Layered (Closed Cup Only) 140-200°F No Flash Exact _ <br /> D001 <br /> Waste Product 0 Homogenous <br /> Shock Sensitive Reactive Radioactive ViscosityWater Haney Motor Oil eOther earttatnspainteJsol(ds <br /> Pyrophoric Etiological p None <br /> C.Density I D.Misc.Regulatory <br /> a Liquid8.4.-- lbs/gallon %Soiids: 0 By WeightQ-15 By Volume Source Code: G11 <br /> Solid lbs/cubic ft. pH: <2 2-5 05.1-9 Form Code: M09 <br /> An debris in waste? Yes w No 4.1 12.5 >125 Exact <br /> Any Odor. None 0 Mild Strong LA.Country Sanitation District Category: <br /> Explain Describe.Petroleum solvent <br /> Oil Organics <br /> E.Chemical Composition(account for t0095oftotal) RANGE METALS PEOCIDES/HERBICIDES(PPM) <br /> Petroleum naphtha,light-medium aromatic( 15- 35 % Total(PPM) x Endrin none <br /> Petroleum distillates 3- 7 % EPToxicity(mgA) _ _ Lindane none <br /> Ethyl acetate 4- 10 % Arsenic(As) < 5 Methoxychlor <br /> _Rona <br /> Methyl acetate 1- 3 % Barium(Ba) <100 Toxaphene none <br /> 1,2,4 trimethyibarizatle ` 2- 3 % Cadmium(Cd) < 1 2,4-D none <br /> ethyibenzene 3- 7 % Chrome(Cr) < 5 2,4,5 TP none <br /> n•Butyl acetate <br /> 2- 9 % Copper(Cu) < 25 Other none <br /> Methyl n amyl ketone 1- 2 % Lead(Pb) < 5 REACnVES/OTHER WASTES(PPM) <br /> Toluene 1- 2 % Mercury(Hg) < 0.2 Cyanides none <br /> Xylenes i 15- 30 % Nickel(Ni) < 20 Sulfides none <br /> Pigments,inert(titanium dioxide,calcium carbonate,limestone,silica) 16- 30 % Selenium(Se) < 1 Halides none <br /> I % Silver(Ag) < 5 Dioxin none <br /> % Zinc(2n) 10,000 PCBs none <br /> F.Shipping and Handling Informatiol Phenois none <br /> D.O.T.Hazardous Material: *Yes No <br /> D.O.T.ID Number:_UN1263 Proper Shipping Name: waste Paint Related Material <br /> C.O.T.Hazard Class:_ 3 PG: II - <br /> klethod of Shlpment:b/55'x_.Drum: Bulk: Other. <br /> C.O.T.Shipping Container: UN drums i projected Volume: 1-21 yr Gallons: Cubic Yards: RQ Amount: 100 lbs <br /> `OMMENTS� e <br /> Generator Certification Statemient <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 /> j knowledge,all known(40 CFR 261)and susp€cted hazardous components have been included in this documentation. All material and packaging will comply with all <br /> current€e4ttlation5,. <br /> Signatu _Print Name:_^Sean McDougall Title: Agent Date: APR 12020 <br /> (Print,sign and send to custofner service) <br />