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05/04/2005 22:55 FAX IaOO4 <br /> �--' LAND DISPOSAL REST .TION NO�III~ICAfIOtd <br /> Parific Manifest LineJs! I <br /> Res <br /> hlanilpt Linc� Ap r°vL_ �I� Line { A rovBll <br /> Reso l.Il h.e Line A40D <br /> ReCOVM i it <br /> 3150 East Pico Boulevard,Los Angeles.CA9W23 <br /> Phone (800)499-7145 Fax (213)780-0078 <br /> i <br /> 7his'notification form shall be completed by ti <br /> eeneralor and shall accompany each shipment of restricted!�as[e subject to <br /> the Land Disposal Restrictions(40 CFR 268 SubpartC)_ <br /> >-Complete all information ire Seaton I- Ilcable Sections and/or corftplete Section III. <br /> T Check mark all appropriate Regulated Constituents in Section II, additional app, <br /> T Sign and date Section IV. _ <br /> GENERATOR'S NAME Go•r,•.-c <br /> EPA I.D.NUMBER o �' <br /> I . <br /> MANIFEST NUM6EA <br /> Chetkons) C] Wastewater Ir] Nan-Wastewater <br /> TREATABILITY GROUP - I E"o .I . <br /> ❑ Yes <br /> HAZARDOUS DEBRIS <br /> EPA HAZARDOUS WASTE CODE(S)- ;I <br /> i <br /> ,I <br /> ❑�,�TThere are no underlying hazardous constituents of concern,or ' <br /> L7 t Here are underlying hazardous constituents of concern which do not meet the treatment standards of 40 OFR 68.48,Table <br /> UTS-UniveafTreatment Standards(see Section II). <br /> hammed:the foliowing to_make the above�aterminatfom - <br /> Q''} nowledge of the waste producing process•Yaw materials used and reac0on products,or <br /> a., nsin7able UTS.. <br /> sfor t >coa8tuaRe-sum of analyslh <br /> ° <br /> Waste analysis data attached?. .-� .. . Q :Yes !� , <br /> _ .I .(Check all thatapplyl ❑11a C) 11c <br /> 11b - Q ❑ ttd <br /> NON-RCRA WASTE, [3LIQUID ❑ S IJO_. .I <br /> Effective 1l31196- <br /> PursuanttoSec6an2Sf79.6ol'he Kealth and Safety code,NON- othen(26a-.2&1 - <br /> aqueous and solid waste ccntafniny orgarues has been repealed Irom � ;� <br /> Land Disposal Reatdction N066eatien re4aremenK <br /> UNIVERSAL TREATMENT STAPMARAS <br /> ---------------- <br /> �T?. <br /> . x .. F6 f9 po01(onlyD001 <br /> Underlying Narardays const%tuenL^mustbe identitfed for a�stc streams which carry the ENonllaste Cedes F0o1-F005, <br /> notirearedhy AORGS;CMBSTror POLLl ru70�-P <br /> (only DOG it treated in NonCWA,Non to Nu ber(sNdelti Afacin 4 268' <br /> fled in 40 CFR <br /> The wastes identified on the aforementioned r�anilest document number and bearing the EPA Hazardous Wasta Ent e Number(s)tdener�ed iSection ce with <br /> subject to the land Disposal Resbictio o�llf I( spedried 4 GFR 268,32(Ceillomla sl was or RCFtA-Sesta .. o : r <br /> Subpart D or exceeds the applicable P 0cable tansatuenis of concern.. <br /> .the requirements of a0.CFR 263-T and Zee-9 we are initicafing belay the app w a°. <br />