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Rancho>Cordova LLC <br /> F. OTHER WASTE STREAM INFORMATION CONTINUED: <br /> Is this Waste subject to RCRA Subpart CC controls?(40 CFR 265 SUBPART CC) _Yes _No <br /> If"No",does the Waste meet the organic LDR exemption for UHC'S?(40 CPR 268.48,268.7) _Yes _No <br /> If"No",does the Waste contain<500ppm volatile organic(VOC)?(40 CFR 265 SUBPART CC) _Yes _No <br /> Does the Waste contain Class I or Class II ozone depleting substances? Yes X No <br /> G. WASTE CHARACTERIZATION: <br /> Is this a Non-RCRA(California-Only)"Hazardous Waste"per 22 CCR 66264? Yes X No <br /> If"Yes",please list all applicable State Waste Code(s): 352 <br /> Is this a RCRA"Hazardous Waste"per 40 CFR? X_Yes No <br /> If"Yes",please list all applicable EPA Waste Code(s): D018 <br /> Is this a"Universal Waste"? Yes X No <br /> H.DOT SMPPING INFORMATION: <br /> Is this a U.S.Department of Transportation(USDOT)Hazardous Material? X Yes —No <br /> /Proper Shipping Name per 49 CFR 172.101 Hazardous Materials Table: <br /> HAZARDOUS WASTE SOLID N.O.S. <br /> Reportable Quantity(if any) lbs <br /> Hazard Class or Division No. 9 UN/NA# 3077 Packing Group: III <br /> Is this a"Poisonous Inhalation Hazard"? <br /> If"Yes",please indicate Hazard Zone Zone A _Zone B_Zone C _Zone D Other <br /> List two primary hazardous constituents: AENZINE GASOLINE <br /> I. COMMENTS: <br /> J. GENERATOR CERTIFICATION: <br /> I hereby certify that the above and attached description is complete and accurate to the best of my knowledge and ability. No deliberate <br /> or willful omissions of composition or properties exist and that all known or suspected hazardous constituents have been disclosed. I <br /> also certify that the obtained sample is representative of the waste material described above and give GEM permission and consent to <br /> make amendment and corrections. <br /> J <br /> Name(print) � '� � ' Title <br /> /Signature —� Date <br /> DATE RECEIVED / / APPROVER'S NAME <br /> PROCESS CODE PRICE UNIT OF MEASURE <br /> PROFILE NUMBER PROPER WASTE CODES <br /> YARD INSTRUCTIONS: NO LANDFILL CUSTOMER _MSDS ATTACHED ANALYTICAL ATTACHED <br /> PERFORM LABORATORY ANALYSIS <br /> NOTES: <br />