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RE,%EIVED <br /> MAY 0 7 2014 <br /> LI <br /> �\ Land Disposal RestrictENVIRONMENTAL Page: 2 of 2 <br /> anHark Notification Form HEALTHWARTMENT <br /> ENVIRONMENTAL SERVICES® Printed Date :Apr 10, 2014 <br /> ---------------- <br /> Certification � Applies to <br /> I <br /> I Manifest Line <br /> Items <br /> ------------------------------------- ---------------------------------------------------------------------------------' <br /> Pursuant to 40 CFR 268.7(a), 1 hereby notify that this shipment contains waste restricted under 40 CFR t1 <br /> Part 268. , <br /> - ----------------------------------- -------------------------------------- I <br /> Waste analysis data, where available, is attached. --------------------'---`--------------- <br /> Signature : Print Name <br /> -------------------------------- <br /> Title : Date : <br /> -------------------------------- <br /> - ----------------------------------------------------------------------- <br />