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CROSBY&OVERTORINC. PROFILE - <br /> Wil?(N,'-!EN.Ai.. RVI(::., <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 Et Dorado St Address: PO Box 450 <br /> City(State)Zip: Stockton,CA 95206 City(State(Zip: Georgetown,CA 95634 <br /> Contact: Steven Slater Contact: Sean McDougall <br /> Phone: 209-751-9946 Fax: Phone: (530)3334684 Fax: <br /> EPA ID Number: CAL000355717 <br /> WASTE PRODUCT DESCRIPTION AND CHARACTERISTICS <br /> Waste Product Common Name-. Urethane resin foam <br /> GenigratingVsrastc Process:._—ReaGteC� or oarfia�y reacted parts A and B resin:foam.S SV telTi-------- --.._.._ _. ___� <br /> A.Hazardous Properties __ B.Physical Properties <br /> U.S.EPA Hazardous Waste? Yes ONcr Physical State: s Solid e Liquid Sludge Aerosol Empty Container <br /> Any free liquids at 701F: a Yes No Color:._tight to dark amber <br /> State Codes) <br /> 272 Layers: Multi-Layered Flash Point <70°F 70-1001 101-139°F <br /> EPA Code(s) Bi-Layered (Closed Cup Only) 140-200°F No Flash OExact.'325F <br /> -none- <br /> Waste Product: Homogenous <br /> Shock Sensitive Reactive Radioactive Viscosity: Water a Honey ®Motor Oil Other foam solid mcontain Iiquid_ <br /> Pyrophorie Etiological o None <br /> C.Density D.Misc.Regulatory <br /> Liquid. t4_ lbs/gallon %Solids: By Weight----- OByVolume'50.------- ` Source Code:__��y <br /> Solid — lbs/cubic ft. PH: <2 02-5 05,1-9 Form Code:__W✓�06 <br /> An debris in waste? Yes ®'Na 9.t-12.5 X12.5 Exact NIA <br /> Any Odor: None a Mild Strong L.A.Country Sanitation District Category: <br /> Explain:____-- i Describe:aromatic— — <br /> oil Organics <br /> E.Chemical Composition(account for 100%of total) RANGE METALS PESTICIDES/HERBICIDES(PPM) <br /> 4,4-diphenyimeth ane diisocyanate 25- 40 Total(PPM) x— Endrin <br /> methylene diphenyl diisocyanate 25- 40 To EP Toxicity(mg/1)__�— Lindane none <br /> polyether(oxyalkylene)polyol 20- 50 % Arsenic(As) c_-5___, Methoxychlor none, <br /> tertiary amines 0- 2 96 Barium(Ba)�100 Toxaphene none <br /> Cadmium(Cd) < 1 2,4-D,_.none <br /> 'A Chrome(Cr) < 5— 2,4,5 TP,none <br /> % Copper(Cu) < 25 Other none <br /> lead(Pb) < 5 REACTIVES/OTHER WASTES(PPM) <br /> % Mercury(Hg) : 0.2 Cyanides none <br /> % Nickel(Ni) < 20__ Sulfides none <br /> % Selenium(Se) < 1 _ Halides none <br /> Silver(Ag) fi_ Dioxin nor?g <br /> 9� Zinc(Zn) 10,000__ PCBs_none— <br /> F.Shipping and Handling Information Phenols_ngna____ <br /> O.O.T.Hazardous Material: Yes o No <br /> U.O.T.Ill Number:. none q y ___ __. — Proper Shipping Name: Non-RCIRA Hazardous Waste Liquid(polyurethane) -- -- <br /> D.O.T,Hazard Ciass:. ,'none_ __._ _—. PG: -none <br /> Method of Shipment:5155a1 Drum: Bulk:—.--_- -- <br /> D.O.T.Shipping Container:__LIN drums Projected Volume:J y_�_......._...Gallons: Cubic Yards:__ RQ Amount: N/A <br /> COMMENTS:.._-__ <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 known(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 /> 5i nature: Print Name. Sean McDougall Title; A ent Date; APR 22 2020 <br /> ( K,sign and send to oust mer servicer <br />