Laserfiche WebLink
STATEW1 lENVIRONMENTAL. SERVICES; INC. <br />{ gND=DISPOSAI:`RESTRI,CTION:NOTIFICATION ' ` <br />INSTRUCTIONS: Complete Part 1. Check and complete Part II or Part III. Complete and sign Part IV. <br />PART ► Generator Profile and Manifest Information' > - - <br />Generator Name: <br />I2AYMCND P.� 1oyo<�T ��' EPA ID Y: CAC001052136 <br />Address: 2245 W. aWA TM WAY <br />_. _- - -- __. ._- ----95206 <br />City' -- State: Zip: <br />Prnfile Number 2W0010 A Manifest Number: Line Item Number: 1 ) <br />Pursuant to 40CFR 268.7, 1 am notifying Statewide Environmental Services that under the above profile <br />number and manifest number, 1 am shipping to you a waste which is subject to the EPA Land Disposal <br />Restrictions, as checked below. <br />Mark one or more as appicable. <br />L] 1.A wastewater identified by the EPA Waste Codelsubcategory that I have checked in Part V; OR <br />2.A non -wastewater identified by the EPA Waste Code/subcatergory that 1 have checked in Part V; OR <br />3.A hazardous debris identified by the EPA Waste Codelsubcatergory that 1 have checked in Part V. <br />Note: A wastewater is a waste that contains <1 % by weight Total Organic Carbon (TOC) and <1 % by weigh <br />Total Suspended Solid (TSS). 40CFR 268.2 (d)(f) <br />California List Notification, if applicable <br />(( 7 4.A D001 -D011 waste which (a)_does (b)_Ldoes not meet the definition of a 'California List waste <br />(see definition below). If (a), I have also checked the 'California List section of Attachment 1, which I <br />am enclosing. Additionally, D018 -D043 apply if wastewater. <br />0 5.A nickel, thallium. PCB, or HOC 'California List waste (see definition below). I have checked the <br />'California List' section of Attachment I, which I am enclosing. Additionally D018-0043 apply if <br />wastewater. <br />Note: If any of the above California List Notifications were checked, identify ALL UNDERLYING HAZARDOUS <br />CONSTITUENTS in Section VI which can reasonably be expected to be present in the waste at a <br />concentration above the constituents - specific treatment standard listed in 40CFR 268.48. <br />Note: A 'California List' waste is (a) a hazardous waste containing Halogenated Organic Compounds (HOC) at <br />a concentration Z 1000 mg/kg or mg/I, or (b) a liquid hazardous waste having a pH < 2.0 and/or <br />containing any of the following materials at a concentration > that specified: PCBs, 50 ppm or (in mg/1) <br />free cyanides, 1000; As, 500; Cd, 100; Cr (VII, 500; Pb, 500; Hg, 20; Ni, 134; Se, 100; TI, 130. <br />6.A specific extension or variance (other than a 'capacity variance extension'), as I have checked on Line <br />B or C of Attachment It, which I am enclosing. <br />7.The waste already meets all relevent treatment standards. I have signed the required certification page <br />of Attachment II, which I am enclosing. <br />B.Lab Pack. I have Signed the required certification page of Attachment t, which I am enclosing. <br />PART 111: `. Wastes'currently 'NOT 'subject 'to Land Disposal Restrictions ' <br />Pursuant to 40 CFR 268.7, 1 am notifying Statewide Environmental Services that, under the above <br />profile number and manifest number, I am shipping to you a waste which is non-RCRA or <br />non -hazardous. The waste is not currently subject to EPA Land Disposal Restrictions because the waste <br />is non-RCRA or non -hazardous. <br />PART <br />Signature: <br />Print Or TypeName: <br />