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y LAND DISPOSAL RESTRICTION NOTIFICATION
<br /> Manifest MMMS0 Manifest
<br /> Line# App roval# Line* royal Line# ApAmW#
<br /> ;;.:• .:
<br /> 27b7 ;
<br /> 9151 '......_..,_......_. 2715277777
<br /> :..`_::.._:. ..,_.• �.. ...........::..'..%:
<br /> P I C 3150 EAST PIC BLVD, 9b2 27bo 2715$
<br /> LOS ANGELES.iGA 90023
<br /> l
<br /> e50�1i'�e abs 27154 27159
<br /> PHONE: 804.49.7145 19M 27155 271510
<br /> ReCOVery FAX: 32,1180.0078 -
<br /> I
<br /> 27151 27156
<br /> This notification form shall be completed by the generator and shall accompany each shipment of restricted waste subject to
<br /> the Land Disposal Restrictions (40 GFR 268 Subpart C).
<br /> >Complete all information in Section I.
<br /> >-Check mark all approprlat4 Regulated Constituents In Section 11,additional applicable Sectl n S it l
<br /> Sign and date Seotidn IV.
<br /> �?., �kv?�L`A 411A
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<br /> �'+a- 1•'ifY� � ?Ci","r � � 1 4 ��4�4 i�'� �PXd` �� 1 s,
<br /> GENERATOR'S NAME lVaflonal,PEt0leurniVViRiPVIi� i�EALT
<br /> EPA I.D.NUMBER ' "'• ' '" ' • '
<br /> MANIFEST"NUMBERTREATABILITY GROUP Check one ❑Wastewater © Non-Wastewater
<br /> HAZARDOUS DEBRIS 17yes X1 No
<br /> EPA HAZARDOUS WASTE G DE(S)-
<br /> .77
<br /> :.Dt301:�
<br /> :``i
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<br /> 1
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<br /> There are no underlying hardous constituents of concern,or
<br /> There are underlying hazar ous constituents of concerti which do not meet the treatment standards of 40 CFR 268.40,Table
<br /> UTS�-Universal Treatment tandards(see Section 11).
<br /> I have used the following to mak the above determination:
<br /> Knowledge of the waste producing process,raw materials usad and reaction products,or
<br /> Results of analysis for the c nstituants in Table UTS.
<br /> blasts analysis data attached? yes [; No
<br /> NON-RCRA WASTE [—I LJQ] 11) ❑SOLID (Check all that apply) ❑9bl ❑9b2 ❑9b3 09ME lecbve'1131/36-
<br /> Pursuant to Section 25179.6 of the f feafth and Safety Code,NON-RCRA er(27b1-771514)
<br /> aqueous and solid waste containing organics has been repealed from
<br /> Land Disposal Rosid then No0catlodt requirements
<br /> t� NIVERSAL TREATMENT STANDARDS
<br /> :�4�.,� .,,,l.Jw...:�.,wS .�¢w r1��D��•,`."'• 4!a �''`J�y.��7a+.�., .`:•.TA,,/Ir/71nw�C�.`1�!Y", '...e,yr,:r,5Aa{[ �l h >2 •Y
<br /> ..>'Y<:.'1r;��'`ytt,E'�.tn�'.fd'sy.:S F c"'rRd.!•A.:}.!.'t+r?-,' a f1tc,r,'lM�yS"JIFrtr""vi4wa'r,,,,`,^^°Rr3iT'-'•'N;1S,fi 1ca?�•rr4'r'x'.�f.a�:". .�; •
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<br /> The Undrlydeg tiaaardous Cansdtuonta must be kkwffied for%wee strtasrtte whkh carry the LPA waste Codes Fool-FOOS,FM,DWI(w0 DOO1
<br /> not treated by RORGS,CMBST or POLVM Db05-DM3(only D005-DM tf treated In Nen-CWA,Non-CWA sqo valent or Man-SOWA fscft").
<br /> The wastes Identified on the aforementioned manifest docomerd number and bearing the EPA Hazardous Waste Numbers)identified in Section 1 are
<br /> subject to the Land Disposal Restrictlpns of 40 CFR 268 Subpart C.The wastes do not meet the applicable treatmerd standards spec-flied in 40 CFFt 268
<br /> Subpart D or exceeds the applicable prohibition levels specified in 40 CFR 268,32(Calllornla list wastes)or RCRA Section 3004(d)_In compliance with
<br /> the regi�rements of 40 CFR 268.7 artp 268.9 we are indcating below the applicable constituents of concern.
<br /> �REfF..`ID�OI,iN,o
<br /> i P*0&1014
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