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appropriate checkbox <br />Waste Determination Documentation <br />Does the waste contain components <br />listed in 22 CCR, Div. 4.5, Ch. 11, <br />i Appendix X? <br />E Toxic - TCLP <br />Page 4 of 6 <br />Index <br />Waste is presumed hazardous <br />i_] unless this presumption is rebutted <br />by generator knowledge or testing <br />Material not toxic I N/A <br />RECENEU"",6 <br />FEB 1 1 2016 <br />ENTAL HEALTH <br />ENVIR OE9ARTMENT <br />