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Crosby and Overton, Inc . WASTE PRODUCT QUESTIONAIRE 115 815 <br /> I.GENERATOR INFORMATION <br /> Generator Name: ROAD RUNNER TRANSPORTATION Billing Name: PATRIOT ENVIRONMENTAL <br /> Address: 1000 E ROTH RD SERVICES <br /> Address: PO BOX 62920 <br /> City,State Zip FRENCH CAMP,CA 95281 <br /> City,State,Zip IRVINE,CA 92606 <br /> Contact: <br /> Contact: RACHEL LOPEZ <br /> Phone: <br /> Phone: <br /> Fax: <br /> Fax: <br /> EPA NUMBER: NON HAZ <br /> Expiration Date: 03-JUN-21 <br /> II.WASTE PRODUCT DESCRIPTION&CHARACTERISTICS <br /> A.Waste Product Common Name: NON HAZ LIQUID-PURGE WATER*LOOSE PACK" <br /> Process Generating Waste: ER SPILL CLEAN UP <br /> B.Hazardous Properties: State Code(s) EPA Code(s) <br /> 1. US EPA Hazardous Waste? <br /> 3. Is Waste Product Shock Sensitive Reactive Radioactive Pyrophoric Etiological X None <br /> C.Physical Properties at 70 deg R <br /> 1. Physical State: 2. Layers 3. Flash Point(Closed Cup Only) 4.Viscosity,similar to: <br /> LIQUID HOMOGENOUS NONE WATER <br /> D.1.Density: <br /> 1.Density 2.%Solid 3.Odor 4. PH <br /> =8.3 LB/GAL =0% 5.1-9 PH <br /> Any debris in waste: <br /> Explain: <br /> E Chemical Composition(Account for 100%of total) Range Metals TTLC: Copper: <br /> 'LOOSE PACK:3 X5 GAL 0 0 % Total(PPM) Lead: <br /> PURGE WATER 100 100 % EP Toxicity (mg/1) Mercury: <br /> Antimony: Nickel: <br /> Arsenic: Selenium: <br /> Barium: Silv er: <br /> Beryllium: Zinc: <br /> Cadmium: Moly bdenum: <br /> Chromium: Thallium: <br /> Cobalt: Vandium: <br /> Reactives,&Other Pesticides,Herbicides: <br /> Wastes(PPM): Endrin: <br /> Cyanides: Lindane <br /> Dioxin: Methoxychlor. <br /> Sulfides: Toxaphene: <br /> PC Bs: P24D: <br /> HOC: P245TP: <br /> Phenols: Pother: <br /> F.Shipping and Handling Information: <br /> 1. D.O.T.Hazardous Material? 2. D.O.T.Shipping Name: NON HAZARDOUS WASTE LIQUID <br /> 3. D.O.T.Hazard Class: 4. D.O.T.ID Number. Packing Group: <br /> 5. Method of Shipment: Drum X Bulk_Other 5. D.O.T.Shipping Container: <br /> 7. Projected Volume: <br /> Comments: <br /> GENERATOR CERTIFICATION STATEMENT: I hereby certify that as an authorized representative of the generator named above,all information submitted in this and all the <br /> attached documents is true and accurate. Analysis of the waste was conducted in a ccordance with the approved test methods in 40 CFR 261 on a representative sample as defined <br /> in 40 CFR 261.20. To the best of my knowledge,all known(40 CFR 261)and suspected hazardous components have been included in this documentation. All material and packaging <br /> will comply with all current regulations. <br /> Generator's Authorized Signature Title Date <br />