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<br /> Land Disposal Restriction Notification
<br /> EPA Number: ,AR 3229'32
<br /> Generator Nance� ;;VS#03908
<br /> Generator Addross, I R85"V s, i'i n Street Tracy CA
<br /> Manifest Tear-king Number, OQB(529256F-LE
<br /> Instructions
<br /> Column 1:List the Manifest Line riumbe.=or Varufers,".ve 4w)l
<br /> Column 2aeqlty iH U 5 ;:PA hazardous Vvaste Codes thal apply to this Shipment
<br /> Column 3: treataboty grouo Non Wa5lewaler(NV VV)or%,Aust ewa!er il'NVv�
<br /> Column 4: Ent,&Vle aDpf0brVe 40 CFP 2f38 4wim,if applicaCie,and also enter Comlarlinaled Soil or 'Debris'if Ire was,e' ll be
<br /> -
<br /> -e'weqco .alteinali%pe treatment technologies provided by 2159 of 268 45 debris
<br /> Column 5: ;:rler;he letter of I,tieapprop r late para-igraph.F=orm beoMsee App-ndrx 1 for oth+-options rt neededl
<br /> Column 6-1 ,1v please enter the Rel"rice below for tre cors,,,ljAjts In yz)ur,,ivasfF,streari 5Lrje"!!Q lrealrloa!
<br /> Coiumn Fc,, 1 0043 Debr,s&Contamraled Sol please list the Reference Nurnoers'isted=r,.Appprz.ax 2 liiY anv J-10erying Hazardrx;s
<br /> Ly t;1"j F,r,I
<br /> Check Olne
<br /> —or,s; uents
<br /> S EPIA HazFdous sob�Caleqv'y '0'laste Be. I-�')f,14
<br /> cf VallrieV L,1e!!er- ")�wp Co�'Jes N,N'W V.FA, Managed' -�'of 900'�FXJ5 ,retlris of Seri
<br /> "D r- r rtes 'A
<br /> 7
<br /> ;}a1
<br /> 03,44E 17-7 D:i 1,� Ves A
<br /> 00- 77.CC^I UC—C2 Yes Hipp TC)C 1•pnjlA
<br /> Liquid
<br /> ;gnl',abe A
<br /> Charecienstic
<br /> Vi ante
<br /> Column 5 Waste Management Codes
<br /> 11 be treat eC
<br /> I HIS'P�ESTRtCIECI'WASTE REQUIRP3 TREATMENT TO THE APPUCABLE$1 ANCAR) 7'lis waste,, ret v to
<br /> [hp apmcan*,performance based treatment standard set font r 4aCFR PaI 268 Scab art C 25F,32 Subpar,UL 268 40 C,
<br /> r-.l7,RA Se-nnn 3004,"ol,pr>or to lar:l dispreal
<br /> Column 6 Pool-F 6 Reference Numbers
<br /> Column 7 DOO1-"3 Reference Numbers
<br /> �e,reby LefIly than aP rrfornat,nr 5t.r 5 rik7Et4i at alit,and ai, S 11 octated'd[y-utnenls is gild accurate to the t'L-s1,'r"F'r1v-'n `ledge ar'd
<br /> Generator Signature:
<br /> Printed Name: Date:
<br />
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