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Land Disposal Restriction Page : 1 of 1 <br /> eanHarbff% Notification Form <br /> ENVIRONMENTAL SERVICES' Printed Date:Jun 30, 2020 <br /> nAANIFEST INFORMATION -------- -------------- ---- ---- <br /> - ----------------------------------------------------------------------------r------------------------------------------------------------- <br /> Generator: CCSF-PUC Tesla Treatment Facility i Manifest Tracking Info. <br /> , <br /> Address: 9000 West Vernalis Road. 014552504FLE <br /> Tracy,CA 95377 I <br /> EPA ID#: CAR 0 0 0 2 8 5 9 3 2 Sales Order No: 2003310780 <br /> l_INE ITEM INFORMATION <br /> --------------------------'------------------------------------------------------------- <br /> - neIt--------- -------- ------- ----------------- - ---------------------------------- <br /> Line Item: rPage No: Prefile Na: rTreatal�ility Group: ; LDR Disposal Category ' <br /> ----------------- ------------------ (f .--_-s--•-J------------)------------------ <br /> 1. p 1-- ' "'--"--"TCH434055-' rN01�-WASTEWATER ;2 This jS sub'ect t0 LDR. ` <br /> -J------------ <br /> E:PA Waste Code_ ____L_r____r___________ L___________________ ; EPA Waste SubCategor ,--____-----------------____-- <br /> D001-wr Ignitables,except High TOC Liquids 3 <br /> D002 Corrosive Characteristic <br /> _________________________+_____-______ __-_ __r______________-..___w_r____-____r__r__r___r___ <br /> • I.1tJE [TEM INFORMATION <br /> - -------------- --------------- ---,_. _ -- ___--_ _-__,-------------------------------,--____ _- __----------------------------------- <br /> line Item: 1 Page No: ;Profile No: ;Treatability Group: ; LQR Disposal Category <br /> , _ , _ <br /> 1 ;1__________________;CH349223 ;NO N-WASTEWATER ; - -- <br /> ' 11 (Labpack Alternate Standard) <br /> -J--------------------L-------------------I-------------------------------J------------------------------------------------- _ <br /> E:PA Waste Code ____� EPA Waste SubCate�or�------------------- <br /> ._----------------------------------------------------------------------- ----------- <br /> D002 f Corrosive Characteristic <br /> D004 'Toxicity Characteristic for Arsenic <br /> ..--------------------- ------------------------------------------------------i - <br /> ------------------------------------- _ <br /> Certification Applies to <br /> Manifest Line <br /> Items <br /> F`ursuant to 40 CFR 26$.7(a), I hereby notify that this shipment contains waste restricted under 40 CFR 311. <br /> Fart 268. <br /> , <br /> , <br /> ..-------------------------•-------------------------------------------------------------_-------------------------------' <br /> .r------------------- <br /> I his <br /> -_--- ___-_---.-.This labpack is subject to the treatment standards specified in 40 CFR 268 Subpart D. I certify under .12. <br /> penalty of law that I personally have examined and am familiar with the waste and that the lab pack I <br /> contains only wastes that have not been excluded under appendix IV to 40 CFR part 268 and that this lab 6 <br /> pack compliance will be sent to a combustion facilityBance with the alternative treatment standards for lab <br /> P <br /> packs at 40 CFR 268.42(c). I am aware that there are significant penalties for submitting a false <br /> certification, including the possibility of fine or imprisonment. <br /> Waste analysis data, where it is a# plyed. <br /> J Y <br /> Signature ------ Print Name <br /> Title . ------ -- _C�'CLV------ Date . ___ -- -- --------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------- <br /> :y. b <br />