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71A V ,4 / Page 1 of ERICKSON Tank Processing JOB #:C—R) TANK CERTIFICATION ************************ PART 1 - TO be completed by the Customer ************ **** *** ** CUSTOMER: GENERATOR: 5• State Waste Codes: o�/ ,_29G33 is el LOCATION 7',P,9G'y', U� _ EPA I.D. : C�o-L,C,i I>`i 77 � EPA Waste odes: TRANSPORTER: :01 1b None MANIFEST#. 2 13 See Attached TANK 1 TANK 2 TANK 3 TANK 4 TANK 5 TANK 6 TANK#: CAPACITY: 7j' jC /f DIAMETER: LENGTH: C7 STEELIGLASS: 1�7i c_P-) LAST CONTAINED: LG = Leaded Gas, UG = Unleaded Gas, D = Diesel, UO = Used Oil, FO = Fuel Oil Specify the material Last Contained if other than above. ERICKSON, INC. TANK PROCESSING FACILITY LAND DISPOSAL RESTRICTION NOTIFICATION FORM e waste represented on this manifest is not generated by a chemical manufacturing plant, coke-by-product recovery plant of petroleum refinery. As such, it is not regulated under 40 CFR Part 61, Subpart FF (NESHAPS for Benzene Operations). Pursuant to 40 CFR 268.71 am notifying Erickson, Inc. that the material described by the above manifest is a nonwastewater, Non-RCRA hazardous waste and not currently subject to EPA Land Disposal Restrictions. Pursuant to CCR 22 66268.7 I am notifying Erickson, Inc. that the material described by the manifest is a metal containing Non-RCRA solid hazardous waste (66268.29(g)), with treatment standard at 66268.106 (a) (3) Table CCWE I-C. It is also an organics containing Non-RCRA solid hazardous waste(66268.29(k)),with treatment standard at 66268.113. Both metal and organic c n 1 on-RCRA solid hazardous wastes are subject to a variance from prohibition from land disposal which expires after I understand that Erickson, Inc. has relied on these representations in preparing it's quote. If these representations are incorrect, I agree to be charged an additional amount according to the schedule of charges in effect at that time. I am an authorized agent1representative of the generator. I certify that all information submitted in this and associated documents is complete and accurate. The tanks on the transport equipment have been numbered to correspond with the information provided above. In the event that the tanks do not correspond to the form, I will pay any and all costs incurred in rectifying the discrepaucy(ies) between the tank(s) and the form. I am aware that due to the inherent uncertainties in measuring the remaining contents of tank(s) that the tank(s) may contain excessive solids or liquids. In such event, I agree to pay the cost of preparation, transportation and disposaUrecychng of the excess material according to the schedule of charges in effect at the time of receipt of the tank(s). Further, I will not hold Erickson, Inc. responsible for any damage to tanks which occurs after the tanks are removed from the ground. n TTTFiORIZED REPRESENTATIVE l SIGNATURE: �/! bpi 5• CcY 5 err 'Z �S DATE: PRINT NAME: P�tc C(t� ire ti/a�� 4.S S l`x ;titC 'r3 TITLE: CJ ua E,ter Ct t,7Y,_A S;TQ 5��✓,�cr For assistance in completing this form, please contact Karen Ruffin at (510) 970-7463.