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SEP 1 9 2017 <br /> Land Disposal$$ Restriction EW110 MENTAI.HEALTH Page : 2 Df 2 Notification Form PERMITrSERVICES <br /> _f MV? t4Kd}f Nii1t Si SSY?Ley Printed Date :Jun 20, 2017 <br /> ---- --- - - --------- - -- - -- -LDR Chemical Data- - - -- --- -- ------------- <br /> ------ <br /> -------..----- <br /> Underlying Coi4tuents Contaminants <br /> Hazardous of Subject <br /> Chemical_ _ _ _ Constituents Concern Treatmerd <br /> MERCURY-RLL OTHERS --------------------------------------------N------- ------N-------- <br /> LINE ITEM iNFORMAT10fV <br /> ----------------------------------------------------------------•----- <br /> _---_-_�_—_—_-----_—r—_—_—_—...__ —_—_—_—_—.y--_--_—_—_—_—_-----_---_—..—_—_— <br /> Line Item: Page Nv: ;Prefile No: Triffiabllity Group: ;LDR D1;Dosal Category <br /> 8- -------T-2 <br /> -_-_- - - -LCCRB- ---NON WASTEWATER - -;2(This i subjed to LDR-) ------------ <br /> t I <br /> _ I <br /> EPA Waste Code---------------------- _; EPR Waste SubQAegorV _ _ - --- - — -- <br /> D002 - -- - - -__- 1 Corrosive Characted tc <br /> Certification IApplies d, <br /> I Manifest Une <br /> I <br /> , Items <br /> Pursuant to 40 CFR 288.7(a), I hereby notify that this shipment<Nmtairrs waste restricted under 40 CFR 1. 2. 3 4 <br /> Part 288. <br /> 5. 8. <br /> This waste is not restricted as speafied in 40 CFR 288 Subpart D. T 7 - <br /> Waste analysis d wher availab atta ed. i <br /> Signature : PrirTtNameT- :i <br /> ---__._--Title : g-_--------- Date : ' --_---_ <br />