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CWn GV'AV-1 RCRA Land Disposal Restriction Notification Form L j iq y (PZ Work Order# Generator: US EPA ID CSA Dq gA6�q Ja No. l Profile No. l � a 1` 50 —(�t� , ��p?`��'(�I Manifest No. The wastes identified on this form are subject to the land disposal restrictions of 40 CFR Part 268.The wastes do not meet the treatment standards specified in Part 268, Subpart D or do not meet the applicable prohibition levels specified in 268.32. Pursuant to 40 CFR 268.7(a),the required information applicable to each waste is identified below(check all boxes that apply): Treatability Group: ❑ Wastewater X Nonwastewater (Wastewaters contain less than 1%filterable solids and less than I%Total Organic Carbon) ❑ D001 Ignitable(except for High TOC)managed in non-CWA/non-CWA-equivalent/non Class I SDWA systems ❑ D001 Ignitable(except for High TOC)managed in CWA/CWA-equivalent/Class I SDWA systems ❑ D001 High TOC Ignitable(greater than 10%total organic carbon) ❑ D002 Corrosive managed in non-CWA/non-CWA-equivalent/non Class I SDWA systems ❑ D002 Corrosive managed in CWA/CWA-equivalent/Class I SDWA systems ❑ D003 Reactive Sulfides based on 261.23(a)(5) ❑ D003 Reactive Cyanides based on 261.23(a)(5) ❑ D003 Water Reactives based on 261.23(a)(2),(3)and(4)managed in non-CWA/non-CWA-equivalent/non Class I SDWA systems ❑ D003 Water Reactives based on 261.23(a)(2),(3)and(4)managed in CWA/CWA-equivalent/Class I SDWA systems ❑ D003 Other Reactives based on 261.23(a)(1) If D004-43 boxes are checked, complete and attach Form UC to address underlying hazardous constituents(unless these wastes are to be managed in CWA/CWA-equivalent/Class 1 SDWA systems): D004 Arsenic ❑D005 Barium g D006 Cadmium ❑ D006 Cadmium-containing batteries D007 Chromium ❑D008 Lead ❑ D008 Lead acid batteries ❑ D009 High mercury inorganic(>260 mg/kg total), including incinerator residue and residues from RMERC ❑ D009 High-mercury organic(>260 mg/kg total),not including incinerator residue ❑ D009 Low-mercury(<260 mg/kg total) ❑ D009 All D009 wastewaters ❑ DO10 Selenium ❑ DOI I Silver ❑ D012 Endrin ❑ D023 o-Cresol ❑ D033 Hexachlorobutadiene ❑ D013 Lindane ❑D024 m-Cresol ❑ D034 Hexachloroethane ❑ D014 Methoxychlor ❑ D025 p-Cresol ❑ D035 Methyl ethyl ketone ❑ D015 Toxaphene ❑ D026 Cresols(Total) ❑ D036 Nitrobenzene ❑ D016 2,4-D ❑ D027 p-Dichlorobenzene ❑D037 Pentachlorophenol ❑ D017 2,4,5-TP(Silvex) ❑ D028 1,2-Dichloroethane ❑D038 Pyridine ❑ D018 Benzene ❑D029 IJ-Dichloroethylene ❑ D039 Tetrachloroethylene ❑ D019 Carbon tetrachloride ❑D030 2,4-Dinitrotoluene ❑ D040 Trichloroethylene ❑ D020 Chlordane ❑ D031 Heptachlor ❑ D041 2,4,5-Trichlorophenol ❑ D021 Chlorobenzene ❑D032 Hexachlorobenzene ❑D042 2,4,6-Trichlorophenol ❑ D022 Chloroform ❑ D043 Vinyl chloride Note: If any bolded entries are checked,form UC must be completed to address underlying hazardous constituents,unless the material is treated in a Clean Water Act(CWA)treatment process. In addition,the following wastes are included in this shipment ❑ F001-F005 spent solvents. (If this box is checked, complete the F001-F005 section on the back of this form. Check the hazardous waste number(s)that applies, and identify the constituents likely to be present in the waste) If this shipment carries additional waste codes that are not addressed above,identify them here: EPA Waste Code Subcategory(if applicable) EPA Waste Code Subcategory(if applicable)