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Waste Determination Documentation <br />appropriate checkbox <br />NO <br />Does the waste contain components <br />listed in 22 CCR, Div. 4.5, Ch. 11, ❑ No hazardous waste presumption <br />Appendix X? <br />Lj <br />Toxic -TCLP Material not toxic N/A <br />Is the waste extremely hazardous per 22 CCR §66261.110? I ❑ I N/A <br />0 Lab Analysis Include lab report <br />Q SDS IncludeMS05 <br />YES <br />❑ Other Additional Info here <br />DisposalLand <br />N O ❑ Waste is not disposed on land <br />NO ❑ If NO, explain reason & process below <br />Ifo waste is destined for anon -approved TSOF, please explain. <br />Page 4 of 5 <br />UP_005954 <br />LlToxic <br />- TTLC/STLC <br />Material not toxic <br />N/A <br />❑ <br />Toxic - LD50, LCso, %wt. <br />Material not toxic <br />N/A <br />❑ Reactive <br />Material not <br />N/A <br />reactive <br />Material not <br />❑ Ignitable <br />N/A <br />ignitable <br />❑ <br />Material not <br />Corrosive <br />N/A <br />corrosive <br />Is the waste extremely hazardous per 22 CCR §66261.110? I ❑ I N/A <br />0 Lab Analysis Include lab report <br />Q SDS IncludeMS05 <br />YES <br />❑ Other Additional Info here <br />DisposalLand <br />N O ❑ Waste is not disposed on land <br />NO ❑ If NO, explain reason & process below <br />Ifo waste is destined for anon -approved TSOF, please explain. <br />Page 4 of 5 <br />UP_005954 <br />