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d <br /> Y <br /> 1 1 <br /> r r� LAND DISPOSAL RESTRICTIONS(LOR) Page of <br /> HESLDRI NOTICE AND CERTIFICATION <br /> Generator Name LWL& EPA I.D.No.: ( JI <br /> Maniiost Tracking No.:vd0-,q^w°._k-. Waste Stream Number. <br /> 6larrt0est ,;..(t (s Ofit p, . . , Raee,o (FdentHr Y CAepripftQiccaabtloie(2) mts <br /> Ka2zrdous Waste Codes ctenl�,EixFONEo <br /> Pa eflJne Item <br /> (1-app, n. <br /> (D- per lithe}£ <br /> 9B1 0001 WW NWW AEROSOLS <br /> WW NM <br /> WW WM <br /> WW NWW <br /> WW NIM <br /> WW M" <br /> WW NM <br /> WW NM <br /> WW NW <br /> WW NW <br /> WW NM <br /> WW NM <br /> WW NW <br /> WW WM <br /> Multple waste codes alowed on a single Enc l le came hformabon In Cdurms 3 ° Er,1or'i W for a<Hazard Codes odor than OWI-DDQ, F001•F005, and F039, <br /> through 6 applies to the waste code cat To fsl additional waste codes ownck e a Cadamhaled Sol, Hazardous Deeds, and Dediaraderized Wase. For these <br /> HeibRe LDR Continuation Form W-SLDR2}Review the Hereage Supplemmtd codes or wasio types„e4w enter the numerical discoidal representation from the <br /> Fooi+005 Spent S&nnVLlnderyig Hazanbus Cons;ft"W039 Leadrafe Form Harlage Sup*rnmW F001+005$Pent S*tnVUndedykhg Const tuenlsrF039 <br /> (HESLDR3) and enter numoric cvnstJtuerl reference It one or more eppkaNe La adhala Form(HESLDR3)or the dnmkbi name(s).If you choose to use the fam <br /> waste codes aro Piol,FOV_F003,F004,FM5,F039,or D001-0043 or l you HESLDR3 ptease tliace an'X'In the Bax in Caimm 5 and cornpleto HESLDR3 by <br /> choose to use HESLDR3,pleaso praco an W In ilio Box Idu&y V a ms&uents using the appropriate Manliest Paganjne KM h there ere <br /> a Cirde eam'WW-Wastehrater a 1~-NorrWesimter based on the waste no eons&errts req 4khg Identification enter'IMNE'In Cohrrm 5 <br /> that Ls being sherd, hrc Choose ham rerffirafions at bollom Of HESLDRt and ender number.Supplemental <br /> c Enter the Subcakgory(ies)app5rabe to Cx waste coda(See Instrodions for Tabie ceMcations may be roqutrod and are prvAded oo ton HESLDR4 in the <br /> of Submbagot a at 40 CFR 2S&40) A nurnerim) erhhry from ilia Tabic of but ixbon Enter only one Ger9call°n Number pet in-- <br /> Subcategories <br /> n✓Subcategories in the Instructions Is occeptabio.Iaave dank or aMer'NA'l tMm See Instrudiotls for Addltlonal h0an,allon <br /> is not a SUmLegory. <br /> if you have a decltaraolertzed waste,contaminated loll,hmxdous debris,lab packs managed try the Altednadve TreatmeM Standard,a waste subject to <br /> an exemptlon,or operate a treatment facifky please refer to certifications on HESLDR4 and enter the appropriate certiticadon number.For Cer fticatJons <br /> (3)and(I Oa),HESLDR4 must accompany HESI..DR1. <br /> (1) Waste Does Not Meet Applicable Tmatment Standards-This is a resbicled waste that does not refect the appficabla treatment standards set forth in <br /> Subpart D of 40 CFH Part 2% <br /> (2) Waste Meets&MUcabto Tmabnal Standards-I oertrfy under pe+>aAy of taw that I personally have examined and am farroTar with the waste through <br /> analysts and testing of ttxough{oaMadge oi the Waste 10 supped this celU)Braliort Ilial the waste complies with the ireatmW standards specified In 40 <br /> CFR Part 268 Subpart D.I befieve thal the hnfwTw&n I subrrvtled is true,accurate and complele.I tart aware that there are significant penalties tor' <br /> subrtftng a false certification,inclu[&rg the possr'br q of a fine and lmptisonmenL <br /> I cedity that U-te Information provi on this and any adRonal pages(HESLDRZ HESLDR3,HESLDR4)of this LDR noUcation is true,accurate <br /> and complete. <br /> Authorized Signature: Print DrType <br /> CampanyfFrrtf9: Date: <br /> o�cEi?no��l a April 2007 <br />