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42 Pacific @p gp�g �[ p 3150 East Pico Blvd, Los Angeles , CA 90023 1 acific Resource Reca e q Phone (800) 499-7145 Fax (323 ) 780-0078 •_ CLIENT AND ENVIRONMENTAL PROTECTION 4vNlw. paoificres0uroe (32317 0-0078 17A -R This notiticahon form shall be completed by the generator and shall a �,� �`� �� OKI F. . }� � accompany each shipment of restricted vdaste subject to the Lantl � 9b1 - 27b2 w 27b7 — Disposal Restrictions (40 CFR 268 Subpart C) . } Complete all information in Section I 9b2 27b3 27b8 P > Check mark all appropriate Regulated Constituents in Section 11 , 9b3 27b4 27b9 additional applicable Sections and/or complete Section III . 9b4 27b5 27b10 }> Sign and date Section IV, 27bl 27b6 GENERATOR ' S NAME /�►T18rICat1 TPUCIC & Tral(t3C BOdy EPA I . D . NUMBER ICAL000128189 MANIFEST NUMBER 021321844JJK TREATABILITY GROUP ❑ WASTEWATER ® NON-WASTEWATER HAZARDOUS DEBRIS ® YES ® NO EPA HAZARDOUS WASTE CODE( S) D001 D018 ® There are no underlying hazardous constituents of concern , or ® There are underlying hazardous constituents of concern which do not meet the treatment standards of 40 CFR 268 , 48 , Table UTS — Universal Treatment Standards (see Section II). I have used the following to make the above determination : ® Knowledge of the waste producing process , raw materials used and reaction products , or ® Results of analysis for the constituents in Table UTS , Waste analysis data attached? ❑ YES ❑ NO NON - RCRA WASTE ® LIQUID ® SOLID (Check all that apply) Effective 1./31/96 — ❑ 9bl ❑ 9b2 ❑ 9b3 ❑ 9b4 Pursuant to Section 25179 . 6 of the Health and Safety Code , NON-RCRA aqueous and solid waste containing organics has been repealed from ❑ other ( 27b1 - 27b10) Land Disposal Restriction Notification requirements . i *._....,< � .ter , The Underlying Hazardous Constituents must be identified for waste streams which carry the EPA Waste Codes F0014005, F039, D001 (only D001 not treated by RORGS ; CMBST or POLYM) , D005—D043 (only D005—D043 if treated in Non -CWA, Non-CWA equivalent or Non-SDWA facilities ) . The wastes identified on the aforementioned manifest document number and bearing the EPA Hazardous Waste Number(s ) identified in Section I are subject to the Land Disposal Restrictions of 40 CFR 268 Subpart C . The wastes do not meet the applicable treatment standards specified in 40 CFR 268 Subpart D or exceeds the applicable prohibition levels specified in 40 CFR 268 . 32 (California list wastes ) or RCRA Section 3004(d ) , In compliance with the requirements of 40 CFR 268 . 7 and 268 . 9 we are indicating below the applicable constituents of concern , llmi vna tom icaa - 12na Page 1 W "r