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rM YrryYY.l,at ��%�r/t2R�Us1•�✓oni -To be completed by the-,--stemrr�VYfFYY4FYNIM1«Yatuw�rs�tt�Ry� <br /> f CtiSTY7Mw,R: GENMATOF-_ State waste Cade:- 5121 <br /> = wear it sr . <br /> I',O ATION. •T"Ir-4 C4 EPA EPA'Nasre Cod=, <br /> "TtANSisOP'FR• - (� None <br /> ( NLAXL=FST ya a .S¢Altadted .. <br /> TANK : .ANK'_' TANK: TANK a :.4NI0 S TA.,I . <br /> fib <br /> ' Stlp 4 -TASK x: 7. 61 <br /> CAIPACII. ;eco ;aao Loc/oa- ;Ooc <br /> ;-tom <br /> LZ <br /> 1 —/ Zc— Z --- <br /> �+.STE=-LIcI1G4SS �•TZ'�L�' .� S � fak4-z <br /> - :.AST cot%tAfNEDt _�_ _� � _L <br /> LG - Leaded Gas, TJX, = Ur)eaded Gas, D . D:=d, UO v tied Cil, FC = Fwc:Gil <br /> Spcifv the material L.% Contained if Mh=t.hati above. <br /> EF,LCKSON, INC TANK PRCCESZING£AaL'TY <br /> LATJD DISPOSAL RES MCTION NOTIFICATION FGcRM <br /> The waste r.pmseuted on his xaaiCest is not gcueated by t chemical tttaattfactuting plant, cors-by-pcodua towrrery plant of <br /> petroleum tertaerp_ .As such, it is not regulated under 40 CM pact 62, SLI-Vat FF(NESEAPS for Ben:=e Opetnt:ow). <br /> ` t~urruat m 40 CFR 268.7 T am aoGfying Mi kW tt.Inc-that the materia!desetihed by the above manifest is a noaw sl--AVer, - <br /> Non-QCR.4 lantdous waste and no,currently subject to EPA and Dsposal Restriu'lons_ <br /> Pursuant to CCR 22 66261: T am notifying Enc:J=n,, Inc. that the tmvjial drubbed by the rut if=t is a mets! containing <br /> N0n-R1 c-k surd*1Ur toga w�- (65268.:Iv(g)),and an organics containing Nan-.2CRAsolid hmrdous wase(6626&24(It7). The <br /> to-n,amr stand-rds.for th=wa.-us have been rtr eared. TLiis wa.'te is no longer subjat to land disposal restrictions. <br /> l.am an authod=d agcnttrprasrmuive of the generaror. I c-ttify that all information submitted in this and a.•sw4ated dowmi al, , <br /> i,tornplete and aavrata to the best of my knawUdga flu tanks oa the transport egnipmc L h:,e b xa tuunbered to eorte•popd with <br /> the?nfomatien provided above In{he even shat the tames do not corttslwad:e the form, I will pay any and ail cost.incurred in <br /> rec:irying the disempaaey(rcs)bwvicen the t=k(s)and the forts Ln the event rJu,t the tank(s)contain excewsive-alas or liquids, I <br /> agree to pay the cost of psepantia.•t, trarsporLtiaa and disposdhrmycling of tiro excess:mater.:!aomediag to tha schedule ofrkarges <br /> in effect at the time of Mwipt ort se.tank(-). F4rthw, I witinot bold t;, cl=a,lnc.responsible for any danuge to tank:which oocws <br /> after the tanks are mmovod from :he ground. <br /> AUTHORIZED REPRESENTA-M,'c <br /> 2 r <br /> �i SIG`A-LURS' Ft (� <br /> --� n¢ to VA!'4& . 7s, !� /E/ Z r„ _ _ kv <br /> Fer sss:=nrr in Mmpledng this fore':, please;:otuaat Kart: Ruffin.at(510;970-745?. <br /> J <br />