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<br /> PH:(62)431.544°5
<br /> WASTE PRODUCT QUE 11ONNAIRE FAX:(562)49 .218I
<br /> GENERAL INFORMATION
<br /> zcfwrator Name; universal ServkcoRecyt ing Inc Billing Name: McDougall Environment
<br /> SAA Addiess: 3204 S E9 Dorado St Address. PO Box 460
<br /> �'ity 1 St i,as(�.'s Stockton,CA 85206 City I State I Zip; Georgetown,CA 95634
<br /> conlaat. Steven Slater ( Contact; Sean McDougall
<br /> P ion" 208.759- i"X: Phone: (530)3334684 Fax:
<br /> LPA It?Number: CAL000355717
<br /> WASTE PRODUCT DESCRIPT'JON ARILS CSiARACTERISTICS
<br /> ` ,fit te€t tw,tict Common Na ne',.....it tharLeresinjoan .._.._ . ...�,�.._ .__.._.,... _ ...�._.. .. r ._...
<br /> nt stisic} ^d<istz fffS��Y CC�9+� DikSs�PZd. .Lln, Cl_
<br /> A.I-fa2ardous Properties I B.Physical Properties
<br /> 1 .LPA i t<zttz r,��7Jasto;i
<br /> Yes, QNo physical State: *Solid 01-1c}uid Sludge Aerosol Empty Container
<br /> ,Any free liquids at 701sr Yes No Color __H�ht to dar9c arn6er
<br /> Stattr Code(sl
<br /> 272 i Layers: Multi-Layered Fiag(1 pcajnt, <70*F 70.1001E 101 139°E
<br /> EPA C ndeW Bi-Layered (Closed Cup Only) 140.200°F No f=lash Ofixat t._'325F_
<br /> none Homogenous
<br /> ad;�s.e t�roduct;
<br /> Shock xr;sitive 0.activt Radioactive Viscosity. Water 6 Haney G tviotorOil #Other_team solid may,contain Igudd._
<br /> i=yrophtarte Etiological None
<br /> D.Misc.Regulatory
<br /> r
<br /> ® 1.icgtrie3 'P---,._ ..._it3s!gallan � .nsoiids; 43yVle(aht6yVolunae?50_».._.._. Sourt:r;>Cotie
<br /> G19..._,:...
<br /> NI
<br /> PH: Form Co"",
<br /> 091-12.5 512,5 OExact — �.
<br /> Any debris in waste? Yes 4)No Odor None ®Mifd Strong L.A.Country Sanitation District Category.
<br /> _ .-.. GaestrilJe,9Tt7RiatIC
<br /> iztxiain _.__ _ __ � �___._ _ _..»__�_ ; O1i Organics
<br /> E.Chemical Composition(account for IO(Yo of total) RANGE METALS PESTICIDESIHERBICIDES WPM)
<br /> Endrin
<br /> 4,44pheny1methanediisocyunste 25- 40 5u Total WPM) _. Lindane nano,_..
<br /> methylene diphonyi dlisocyanate 25- 40 % EP Toxicity(mg/1)
<br /> polyether(oxyalkylene)polyol 20- 50 % Arsenic(As) < b__-- Methoxychlor none___
<br /> tertiary amines 0- 2 Barium(Be) c 9Ut} Toxaphene none_
<br /> Cadmium(Cd).< _?.. _ 2,4.D
<br /> 96 Chrome(Cr)»�__. 5 2,4,5 TP tone
<br /> Capper(Cu) < 2b Other nnno _
<br /> Lead(Pb) < _ REACTIVEVOTHER4VASTES(M)NI)
<br /> kt, €viorcury{ply} < 0.2 Cyanides ncme
<br /> r� Nickel(N0.1_____1_ Sulfides
<br /> 5 Selenium(Se) r „fir Halides none.,,,,.
<br /> "a Silver(Ag) < 6.,_., Dioxin nova
<br /> Zinc(Zn)
<br /> Phenols..none__..
<br /> R`.shipping and Handling Infprmatic r,
<br /> ,,t�x i?aardous Aat.°r al Yrs *No!
<br /> D1 T.ID Micmac r, none _� ._. _._. Proper Shipping Nance;. Non RCRA Hazardous Waste Liquid{polyurei#mne}
<br /> R:=thcsd of hEPrnent:,5t 65 jai Drur
<br /> UtS,l.51-lipping Container .URI drums`I.._ Projected ted ttalttmo.,if Gallons:»..._�_...CuhicYar&______ _.RQ Amount.
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<br /> Generator Certification Tent
<br /> <ers` y c rtify t a.as an authoria d repsese tatiee of the generator named above,all information submitted in this and all the attached deaz;urnents is true and arcuraw,
<br /> #4r P lysis of chn wa t vas<and ctstd in actor once with the appruvai test methods In 40 CFR 261 on a representative sample as defined in 40 CPR 261.M To the be,,t of my
<br /> nnaa#c
<br /> ,je,ail kriumt(40 C:F€1 F6f)and sus ecteri hazazdaus components havL tieen€nduded In this documenw1jon, Ail material and packaging will comply with all
<br /> cumtt r 2gvlltio 3s . `
<br /> 51gr Gat r : _. r€t;t Natv1 :_5ean McDougil Tit, :..,Agent Cat :,APR 22 2020
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<br /> fit,sign and semi to[us r mer seruYceJ
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