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6enbr�l EnYlronroe�t61 M na Inc. <br /> LAND DISPOSAL RESTRICTION NOTIFICATION FORM l <br /> /J� / /} n Page!of� <br /> Generator Nam e/C or���n ZAA A /d!<CA $� " �/,����/ (� S'S 2jfj <br /> EPA M Number l///lllJ���1111���n Manifest Number b z F ' <br /> Waste Analysis Available Yes No On file at facility <br /> PROFILE# RCRA NON- RCRA WASTE SUBCATEGORY REGULATED UNDERLYING <br /> REGULATED CODES (See Table II and TREATABILITY GROUP CONSTITUENTS HAZARDOUS <br /> Please check if (List all that Select Key#if Please check the applicable FOR Foot,F902, CONSTITUENTS 1 <br /> waste stream is apply) applicable) treatability group F003,F004,F005 FOR D00I•,D002, <br /> not regulated by D003•,D004•DO43 <br /> RCRA <br /> Non-wastewater Wastewater List all applicable List all applicable <br /> >I%TOC& constituents from constituents from <br /> >1%TSS key below Tablet <br /> a b c d e f g It <br /> S L, <br /> REGULATED CONSTITUENTS FOR F001,F002,F003,F004,F005(for Column g) <br /> 5)Acetone 12)Cresylic Acid 19)Methanol 26)Toulene <br /> 6)Benzene 13)Cyclohexanone 20)Methylene Chloride 27)1,1,1-Trichloroethane <br /> 7)n-Butyl Alcohol 14) 1,2-Dichlorobenzene 21)Methyl Ethyl Ketone 28) 1,1,2-Trichloroehtane <br /> 8)Carbon Disulfide 15)Ethyl Acetate 22)Ethyl Benzene 29) 1,1,2-Trichloro-1,2,2-Trifluoroethane <br /> 9)Carbon Tetrachloride 16)Ethyl Benzene 23)Nitrobenzene 30)Trichloroethylene <br /> 10)Chlorobenzene 17)Ethyl Ether 24)Pyridine 31)Trichlorofluoromethane <br /> 11)Cresols(o,m,or p isomers) 18)Isobutanol(Isobutyl Alcohol) 25)Tetrachloroethylene 32)Xylene(Total) <br /> I certify un penalty of la that the above information is accurate and tru�e-.+ ',,/ <br /> Signature `' �� Print Name JVP6_5k 13 PI�A Date ^� ' <br />