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1D W- i <br /> 3150 East Pico Blvd. Los Angeles,CA 90023 <br /> // Pacific Resource Recoverq FEB 2 8 2020 Phone(800I499.7145 <br /> I Fan(3231780.0078 <br /> l ��� CLIENT AND ENVIRONMENTAL PROTECTION www. acificresou ce ec <br /> � p r r overy.com <br /> \1RONMENTAL <br /> This notification form shall be completed by the generator and shall <br /> accompany each shipment of restricted waste subject to the Land 9b1 21b2 27b7 <br /> This <br /> Restrictions(40 CFR 268 Subpart C). <br /> Complete all information in Section I 9b2 27b3 27b8 <br /> � Check mark all appropriate Regulated Constituents in Section 11, 9b3 27b4 27b9 <br /> additional applicable Sections and/or complete Section III. 9b4 27b5 27b10 <br /> Sign and date Section IV. <br /> 27b1 27b6 <br /> SECTION I <br /> GENERATOR'S NAME van Buskirk Golf Course <br /> EPA I.D.NUMBER CAL000368928 <br /> MANIFEST NUMBER 021323913JJK <br /> TREATABILITY GROUP ❑ WASTEWATER Q NON-WASTEWATER <br /> HAZARDOUS DEBRIS ❑ YES 0 NO <br /> EPA HAZARDOUS WASTE CODE(S) <br /> D001 D018 <br /> ® There are no underlying hazardous constituents of concern,or <br /> ❑ There are underlying hazardous constituents of concern which do not meet the treatment standards of 40 CFR 268.48,Table UTS—Universal Treatment Standards <br /> (see Section ll). <br /> I have used the following to make the above determination: <br /> ❑X Knowledge of the waste producing process,raw materials used and reaction products,or <br /> ❑ Results of analysis for the constituents in Table LITS. <br /> Waste analysis data attached? ❑ YES ❑ NO <br /> NON-RCRA WASTE ❑LIQUID ❑SOLID (Check all that apply) <br /> Effective 1/31196— ❑ 9b1 ❑9b2 ❑ 9b3 ❑ 9b4 <br /> Pursuant to Section 25179.6 of the Health and Safely Code.NON-RCRA <br /> aqueous and solid waste containing organics has been repealed from ❑ other(27b1-27b10) <br /> Land Disposal Restriction Notification requirements. <br /> UNIVEBSAI TREATMENTSTANDARDS <br /> SECTION 11 <br /> The Underlying Hazardous Constituents must be identified for waste streams which carry the EPA Waste Codes F0014005,F039,D001(only D001 <br /> not treated by RORGS;CMBST or POLYM),D005—DO43(only D005—DO43 if treated in Non-CWA,Non-CWA equivalent or Non-SDWA facilities). <br /> The wastes identified on the aforementioned manifest document number and bearing the EPA Hazardous Waste Number(s)identified in Section I are <br /> 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 <br /> 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 <br /> the requirements Of 40 CFR 268.7 and 268.9 we are indicating below the applicable constituents of concern. <br /> ria+—tam-vin <br /> Page r of,$ <br />