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<br /> FX, (2Qa) 892.67,2 ^dam
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<br /> P.O. box 1E7 Phi EFSON. CA 5343 ( 92
<br /> LAND DISPOSAL. RESTRICTION NOT?=-CA------ ---------------------------ION
<br /> CALIFORNIA
<br /> PART 1 . Generator Inform an Q_
<br /> T Tye IC� EPA
<br /> TD»
<br /> 1 . Generator Name: Ifv� - q
<br /> nanif'est� ! ] 1 rZ
<br /> 2_
<br /> Profile Number
<br /> The waste( s) identified an the above reverenced manifest and bearing the California waste
<br /> he Land Disposal Restrictions of CCR , Title 22,
<br /> number( s) identified below is s:oject to t
<br /> Division 4 .5 , Chapter LQ - ------
<br /> ---_--_____--------------------- ------- -
<br /> -`
<br /> ------- —'------------- '-
<br /> ------ —_-._--'—
<br /> PART _11 : waste Identification
<br /> Calif22-
<br /> waste z
<br /> check the approcriate lines. More than one line may aPP1Y .
<br /> 1 . RCRA regulated waste ( T_f this line is checked, Please complete. other side )_
<br /> T 2.>.t�aste Oil-P.queous wasLes with organics identified in CCR , T_Lle 22, 66268 -117-
<br /> Prohibition
<br /> 6268 .112Prohibition date effec_ive 5/8/52. `
<br /> 3 . Non-,RC 'A metal_conLainng aqueous waste zcent tied i- CCR, Title 22, 66268 , 107( 4 ) .
<br /> c ,° Non-RCRA solvent writs identified in CCR „ Titie 22 , 676268 . 1.07(b ). Prohibition
<br /> ef`ective data 1/3195 . ;- i ?2 66268 , l0e( a )(3).
<br /> _ 5_ Ndn-RC7etal-containinS solid wzste ldenti'f_ed n CCR , T _ e
<br /> Prohibition erfeGLive date 1/1/95 .
<br /> 6 . Non-PCRA aqueous and liquid waste containing any organic _cor„bound idencifi=d by EPA
<br /> Test Methods 8080 , 8140 , 8150 , 6240 , and/or ,8270', identified in CC:Z, Title 22 .
<br /> 66268.3.12. Prohibition, effective dale
<br /> 7 . Non-RCRA solid waste containing any organic compound identiTied .by EPA Test Methods
<br /> 8080 , 8140 , 6150 , 8240 , and/or 2270; identified in CCR. Title ZZ , 60268.113.
<br /> Prohibition effective date 1/1/95 . a .category includes Ido packs, Calif-ornia__,_
<br /> _
<br /> S . Other Non-RCRA. California regulated wast_ , ,
<br /> extremely s^a1l ,quantlzY generators , and household hazardous waste exempted in the
<br /> Health and Safety Code Seccio'--, 26L79 .9 .
<br /> PART 1-1-1 :
<br /> ---------------------
<br /> Handling Method
<br /> Check the appropriate lines. more than one line nay apply.
<br /> _ The RCPa waste identified above must be handled in accordance with the EPG Land
<br /> t -
<br /> Disposal rRestriction Notification included on the reverse, side of this r orn.
<br /> z: RecYcling-
<br /> _ 3 . The waste iaenzified above must be treated to meet the apQ'Licable standards. in CCR,
<br /> Title 22, Division 4.5 .•Chepcer 8 , _Article
<br /> 4 . The waste identified above meets the apvlic--b a treatment. standard.
<br /> I. certify under penalty or law that I Personally have examined and am familiar with
<br /> the waste through analysis and testi Implies
<br /> or through knowledge of the waste to support
<br /> this cer-ification that the waste complies with the treatment standards specified in
<br /> CC.R Title 22, Division d.5, CaOter 18, Article 11 . ? be}i- the information I
<br /> that
<br /> submitted is true , acc,,race , and complete. ? am aware that there era significant
<br /> penalties for submitting a false cer_ification, including the possibility of a fine
<br /> and imprisonment. '
<br /> 5 : The waste identified above is subject to a variance _ The ex=;racion Gate or the
<br /> variance is Find and insert. tie ac=ual Prohibition effective date from
<br /> Par:. I? above .
<br /> 6 . The Nan-RCRA waste identified above is not currencly rest~'-Gtzd from land disposal .
<br /> PART iv _ Generator Cerzificacion
<br /> L hereby certify that all information supplied above and on all associated documents is
<br /> true , comclete and accurate to the best of my knowledge and that no omissions or errors
<br /> exist_ ,,
<br /> Oa to
<br /> 5iSnacura
<br /> Print or TYpe name
<br /> /`1 S S
<br /> C G /u LLQ C R s rvT
<br />
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