Laserfiche WebLink
11-11-' 1410:00 FROM- C* Environmental 661-322-8883 • T-187 PRL4J3 _ED <br /> APR 08 2015 <br /> LAND DICP00AL R : GTRICT10N ro. RM ENVIRONMENTAL <br /> 4FArr oNME1V .r <br /> _ FP,1gr1dCNr <br /> Geoerafor Nam e: uG q �� �nii�`�iu� EPA (DR _ _64L()0()3! <ja77 <br /> AdJroeo. .31�-_5_.�ul�'�iAe_Gcv_` MAN Ir CCT6 <br /> Fxis— <br /> P u teuant to CCR Title 99, Section 66968.7 (40 CFR 9¢8 7), 1 botchy notify that this waela ehipmgnl cunloinr'one or mora of the <br /> following wastes restricted under The land disposal ieslrlclWit for which applicable freatm enl slandafds aro sol foflh In CCR Title 22. <br /> Chapler 18,Lend DispasalReelric Nons. <br /> LDR Waste Determination Underlln8 Waste <br /> Manifest Notification ofWasle Hazardous Water <br /> Line FPA 0odes S (A Ihru F) Disposal ConsfTluen or <br /> Item State Codes D eserlp flonl (A of B) is Hon 4lasto <br /> Num Dor LIST ALL Subcategory (A,D or c) Water <br /> 2. 3. 4. <br /> ('����� r(o n <br /> NON <br /> 2 NON <br /> 3, NON <br /> _77- <br /> CERTIFIC A TIO N: <br /> I certify under penally of Taw that I personally have evam feed and am familiar wNth the was Is Ina roug ho naly s is and les ling, or Ihtougit <br /> knowledge of the process generating the waste, to support this certification. I believe that the inform alion that I submitted is Iru e, <br /> accurate and complete. I am aware that there are significant penalties for submitting a false Certification, including the possibility at a <br /> fine and its prisonment. <br /> GENERATORIC PANY NAME DATE <br /> �2 ---- ----------- <br /> AUTHORIZED SIG ATU RE PRINTED NAMEITITLE <br /> i <br />