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cific <br />Resource <br />Recovery <br />3150 East Pico Boulevard, Los Angeles, CA 90023 <br />Phone (800)499-7145 Fax (323)780-0078 <br />Manifest <br />A roval # <br />Manifest <br />Line # Approval # <br />Manifest <br />Line # A roval # <br />6329 <br />T <br />_ <br />�� �'��t `v%1��i"'.? t <br />/� i <br />GENERATOR'S NAME <br />,✓ �°�/d' �-r�✓-.. r'`i <br />,/ <br />MANIFEST NUMBER <br />rf1 f J ,� �� 7^') <br />TREATABILITY GROUP <br />(Check one) ❑ Wastewater <br />Non -Wastewater <br />This notification form shall be completed by the generator and shall accompany each shipment of restricted waste subject to the <br />Land Disposal Restrictions (40 CFR 268 Subpart C). <br />Y Complete all information in Section I. <br />Check -mark all appropriate Regulated Constituents in Section III, additional applicable Sections and/or complete Section IV. <br />A Sign and date Section II. <br />x <br />�' 4 ' 4�j-��'R �L. �8 C' h �'t � � � t�� �i �4 � � � � a�.+i �, '3 C kid ; y E 9 �� � <br />� � 7..� <br />�I ��� � <br />,{ ✓"9 � K ;� r t" it f � <br />T <br />�� �'��t `v%1��i"'.? t <br />/� i <br />GENERATOR'S NAME <br />,✓ �°�/d' �-r�✓-.. r'`i <br />,/ <br />MANIFEST NUMBER <br />rf1 f J ,� �� 7^') <br />TREATABILITY GROUP <br />(Check one) ❑ Wastewater <br />Non -Wastewater <br />❑ Yes <br />5d No <br />HAZARDOUS DEBRIS <br />CYH nmz-mnuvvo <br />rr„v e ` <br />F003 <br />- —wi --- <br />F005 <br />- <br />D001 <br />There are no underlying hazardous constituents of concern, or <br />Ll There are underlying hazardous constituents of concern which do not meet the treatment standards of 40 CFR 268.48, Table <br />UTS - Universal Treatment Standards (see Section III). <br />I have used the following to make the above determination: <br />Knowledge of the waste producing process, raw materials used and reaction products, or <br />❑ Results of analysis for the constituents in Table UTS. <br />Waste analysis data attached? ❑ Yes <br />No <br />NON-RCRA WASTE ❑ LIQUID ❑ SOLID (Check all that apply) ❑ 11 a ❑ 11b ❑ 11 c ❑ 11 d <br />Effective 1/31/96 - <br />Pursuant to Section 25179.6 of the Health and Safety Code, NON-RCRA ❑ other 28a - 28i <br />aqueous and solid waste containing organics has been repealed from ( ) <br />TT= <br />Land Disposal Restriction Notification requirements. <br />/hereby certify t at 11 i formation subrp'R ed in this a all ays l ciated ocume is is c pI teand accurate to the best of my knowled r}u tnro�m� <br />r�I.- r z���i'/f�-' Date: <br />Company 1\16MW <br />Authorized Signature:�p <° ,_ %� =__d� `Pr ed Name: ~� <br />tJJVERSAL TREATMENT STANDARDS <br />The Underlying Hazardous Constituents must be identified for waste streams which carry the EPA Waste Codes F001 -F005, F039, D001 (only DOW <br />not treated by RORGS, CMBST or POLYM), D005-DO43 (only D005-DO43 if treated in Non-CWA, Non-CWA equivalent or Non-SDWA facilities). <br />The wastes identified on the aforementioned manifest document number and bearing the EPA Hazardous Waste Number(s) identified in Section I are <br />subject to the Land Disposal Restrictions of 40 CFR 268 Subpart C. The wastes do not meet the applicable treatment standards specified in 40 CFR <br />268 Subpart D or exceeds the applicable prohibition levels specified in 40 CFR 268.32 (California list wastes) or RCRA Section 3004(d). In compliance <br />with the requirements of 40 CFR 268.7 and 268.9 we are indicating below the applicable constituents of concern. <br />Page 1 of 3 <br />PRR Form LDSNI R1v4 - 1/03 _ <br />