COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

PaafiCLAND DISPOSAL RE RICTION NOTIFICATION Resource Mani/est Manife Manifest Line# Approval# Line# A royal# Line# Approval# Recovery 11a 6329 3150 East Pico Boulevard,Los Angeles,CA 90023 Phone (800)499-7145 Fax (323)780-0078 11b 6334 This notification form shall be completed by the generator and shall accompany each shipment of restricted waste subject to the Land Disposal Restrictions (40 CFR 268 Subpart C). > Complete all information in Section I. > Check-mark all appropriate Regulated Constituents in Section III, additional applicable Sections and/or complete Section IV. > Sign and date Section II. SECTION I GENERATOR'S NAME EPA I.D.NUMBER MANIFEST NUMBER TREATABILITY GROUP (Check one) ❑ Wastewater til Non-Wastewater HAZARDOUS DEBRIS ❑ Yes No EPA HAZARDOUS WASTE CODE(S)- D001 F003 F005 There are no underlying hazardous constituents of concern,or ❑ There are underlying hazardous constituents of concern which do not meet the treatment standards of 40 CFR 268.48,Table UTS-Universal Treatment Standards(see Section III). 1 have used the following to make the above determination: X Knowledge of the waste producing process, raw materials used and reaction products, or ❑ Results of analysis for the constituents in Table UTS. Waste analysis data attached? ❑ Yes No NON-RCRA WASTE ❑ LIQUID ❑ SOLID Effective 1/31/96- (Check all that apply) ❑ 11 a ❑ Ito ❑ 11 c ❑ 11d Pursuant to Section 25179.6 of the Health and Safety Code,NON-RCRA aqueous and solid waste containing organics has been repealed from ❑ other(28a-28i) Land Disposal Restriction Notification requirements. _SECTION it I hereby certify that all information submitted in this and all associated documents is complete and accurate to the best of my knowledge and information. Company Name: Date: Authorized Signature: Printed Name: UNIVERSAL TREATMENT STANDARDS SECTION III _ The Underlying Hazardous Constituents must be identified for waste streams which carry the EPA Waste Codes F001-F005,F039,0001(only Door not treated by RORGS;CMBST or POLYM),D005-DO43(only D005-D043 if treated in Non-CWA,Non-CWA equivalent or Non-SDWA facilities). The wastes identified on the aforementioned manifest document number and bearing the EPA Hazardous Waste Number(s)identified in Section I are subject to the Land Disposal Restrictions of 40 CFR 268 Subpart C.The wastes de not meet the applicable treatment standards specified in 40 CFR 268 Subpart D or exceeds the applicable prohibition levels specified in 40 CFR 268.32(California list wastes)or RCRA Section 3004(d).In compliance with the requirements of 40 CFR 268.7 and 268.9 we are indicating below the applicable constituents of concern. Page 1 of