FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

Oct, 06 03 07:46a PR' Environmental IF' -9)233-4284 P.8 "I"^� i r - -er tKVIC�S, INC. dI11T11�dJtIBd. Cafil a Land DisposaVRestriction Information Notification/Certification Form This larrn 19 SUDtnitted in accardance with the requirements of 22 CCR 66268.7(a) Chapter 18 which restricts land dlsposw of Certain h=arde The appropriated Callon -4 wasla cege(s) and appik wo non-RCRA hazardous portions of Pan I. If the waste I8 non-harart9ouJ or not ns6 cted [hrn cam lets on ate It6tlngs f °nt CCR 66ZE8.29 are noted i7elow. C� nater• of the page. OtherWiee complete �srt I, I( atld 111, P IY app4cabfe portions in Psrt I and signfdate the form at the IboGoa and 314NCate the form at the bottom of the page. (For RCRA wastes, use Satery.lgeen RCRA Form) I. GENERAL INFORMATION REGARoING GENERATOR & WASTE STREAM GENERATOR'S NAME{ ' LS SITE LOCATION: t PHONE: lS�c1�-TO/J �a� Cpl Zz--Z ZI �� 227_7 ZZ IS THIS WASTE NON-ygZgfi00U57 $ N0, G PROFILE NUMBER: Yc5 (if YES stop here and sign/date form at the Sarrnm of page) GENERriTOR'S EPA 101 MANIF=ST r CA WASTE COOS IS THIS WASTE R=STRICTE07 SES (SI NO (i! N0, 9TC. here and sigrVdate form at the t:ortart of pa(;e) LS NCTFjcAT10N 3 Cc-r� T IFiCAT10N 15 @ASCD ON Tr(E FOLLOWING IN=ORMATION: A) CHcMICALIFHY$ICAL.4NALYSIS OF THE WA5T';; G (8) GENERATOR KNOWLEDGE CF T-E'01F.Si_; OR � (C)EOTr: 3ta app -ppr'c the aCcr_prifro boxes in -3) I) be 111. If e' oily one nedfic7ticn a; cfi?s. ►tier. III(A) is 1101 recuired. Fcr muttipie certi,ica6e.-sinodficatie.1ts, -n* -!Ing an a cat°ices art I Fart 11 (1-3) may .n marked p�1 IIIA) b ndi ate haw waste is to be meragr+ to c nfcm with Land Disposal Resiic:ices. 9v IIaidnq .e^TYPE item LOR NLOTIFICATION/CERTIthe ceT1 Ncnrn0ttticapor. noted in pan 11. . 1 • - NCTIFIG;.TION QINI 1Vd 5 T = I MAT CURR=_VTLY R=QUIRE TR:4 i M=NT TO 4t�=T THE 22 C^R e S7 ARDS: 4 CCR 7-5265,7(a)(1) A+. <CL� 11 TTcEATMENT V NOTIFICATION S CERTIFICATION: WASTE THAT MATS THE 22 CCR ARTICLE 11 TREATME'rT STANDARDS N , TR;ATMENT REQUI r•^ _ RED: _ . ri .� Z'S51(z)(2) , O AODITICNAL L 1:�^rrr unCerpenany ottaw fiat tiler -Woos ,leave exon reed ane air!anCartviy the wa_-ta th..rougil anatr sand to any theu5tr knowledce o; ^e waste h_� s 7, an :tris crdi-ecadon' Char 6@ wawa camp5as wkl; the traamea. Vardz= spa C�Iled in CCR 71e 2� Division ..5. Chapter7�, r:ruc;es 4 and 71 and ah@ h7;'i M6 p/nhihiffcn4 Soft;.rwh In CC,z Tda ?Z Sec"n 66268.32 orRCRA Sac:cn .?004;0)(.;2 U.S.C. Secacn se c�rdh elleve Ural Cie urfom)o8an 1 subm wed is ave, ec._urato and cc rplero. l am aware that tore ora sSrri coni oanaldes for cac r�^n y a -atfon, ine rdtr g me possictTry of a (are orimp=C17rlerc 3. NOTIFICATION & CERTIFICATION: NQN-RCRA WAS =THAT HAS BEEN TR=AT=• 2 TO MEET ALL APPLICABLE 22 C,^,R ARTICLE 11 TREATMENT STANDARDS � �J AT AN OFr'S1TE TREATMENT,7UA.,S S C I =srtity inderpenaft� atlaw B at l e t CCR S23t+.7(B)(5} Cte wase P /scnatly he azam.ned and am ram far with Lha waste ttlrrugh arslys� and ter Ing oi ro suFrort this carw7cadon. Mat the wasde camp0as niCr rhe treatment standards spe:3edin CCR - t s 'n orArticle= 4 and 11 and all apt�rcabla prohlbi6onK6PA Secar. 3804 d 8,acktro.:.urateand compere, 1 am aware! yet there ora �;r fr* sntpenaaratsta cart4lcadon, ir�uJyofadnaormpnt=nmendLDR NOTIFICATIONICErRTIFICATION INFORMATION REQUIRED 8Y 22 CCR -r (A) (� Check Che --k 12 or from Prohlhklon (C) Su (D) aFarepriat handling information Ejy�CmY 1K ae:L: ed Waste (�. CCR fi6:68 29 a.m) arKt Treatabil st Grcup(r) Cortrr ndtn e tcxee (Gari IpOwea26e.10C(a)(1 a) � 8 e .Treatment y 1. G (❑ i C 2 C J 5candard ` I 1125+90 Aqueous wastes ecnn inin -� o !from 22 =R) O �❑ 1 9 mei2l6 [6c�68� 0 6 O 2 O 3 I 3/x/91 662ea.ta7 Table a .�.v I O t IAtrio anroaaerwasn (5aiea 290 S 6b268.700(a)(7)[ O ❑ - ❑ 3 1nl91 3 (66ZBe.tOd Table 1-r, G YYE I Fttzardous Waa1e Fountlry sand I6826d(e) 6V58,100(a)- a �- ❑ t.: 1 ❑ 2 ti6:Er8,106 Table 7-9 C'iCW� C 3 1n1H1 Fly asn, bottom ash, felon ash ar traghauas weale (6fi1381g(h) S 56266.t00(a)(8)1 1 64268.106 Table 1- CC1N �. '- I.^. 1 G 2 C 7 111/91 it IBa9—aa Yoga tom touncnes (6636SM(D b C6'26a,100(a)(9) 1-0 6. 0 IO 1 ^_ 2 03 3/1/93 bihor os Cor tai rhe itlentined in se,on 86268.29 m 66268.1 a 13 t2 j66268.t[66268-1aa Table 1 6 CCN!: 7. 0 ❑ 1 G 2 trip I ( ) " �( )( )1 O J Other (h): Copies a al:ocabte treatment starldartl3 and ws3te analysis data (Wharf) avallaole) are maintained at the cacti ;3 referenced al=Ove. ty identtfre0 cn ttic manifest .r N- GENERATOR AUTHORIZATION /CERTIFtCArtON I hereby c, 2n that alt Intorrnaticn submitted in this and all associated documents is true, complete. and accurate to the best of Information, and that no omissions or errors eydat, I warrant that I am an authcri:xd re resenta p P tive of the generator. my knowledge and LAoled—zz i ature �" :s t'//t we --ate OCUfdENT. WITH AN ORIGINAL SIGNATURE, MUST ACCOMPANY EACH WASTE SHIPMENT. A COPY OF THIS CERTIFICATION, ANO ALL SUPPORTING DATA. MUST BE RETAINED ey THE GENERATOR FOR AT LEAST FIVE (6) YEARS AS PER 22 CCR 4662613.7 r .r 10/06/2003 MON 07:40 [TX/RX NO 64441 Z 008