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06 / 11 / 2021 1 : 47 PM FAX 2090488625 AMCE SAW 0005 / 0007 <br /> stericircle Eli 1 011122011tal S011411011S <br /> RCRA Latin Disposal Restriction !notification Form <br /> Work Order # <br /> Generator; � � _ U5 EPANo <br /> PSS Profile �t 1 _ Manifest J a �j43 61 <br /> No . .�,.(j � � i�io. iX Q <br /> The wastes identified on this form are subject to the land disposal restrictions of 40 CPP. Part 268. The wastes do not Meet the treatment <br /> standards speciiletl in part 268 , Subpart D or do not meet the applicable prohibition levels specified in ?6$ . 32. Pursuant to 40 CTR <br /> 268.7(a), the required information applicable to each wasie is identified below ( cheek all boxes that apply) : <br /> I'rcatability Group: rl Wastewater X Nonwastewater <br /> (1pFastewateta contain less than 3 %filterable solids and less than Ma Poral Organic Carbon) <br /> D001 Ignitable (except for Nigh TOC) managed in non-CWA/non-CWA-cquivalent/non Class I SDWA, systems <br /> DOD I Ignitable (except for High Tilt)) managed in CWA/ CWA-equivalcnt/Class I SDWA systems <br /> DOD ] High TQC Ignitable (greater titan 10% total organic carbon) <br /> ❑ DO02 Corrosive managed in non•CWAInon-CWA-equivalentfnon Class I SUWA systems <br /> ❑ DOO2 Corrosive managed in CWA/ CWA equivalent/Class I SDWA, systems <br /> lr} D003 Reactive Sulfides rased on 261 .23 (a)(3) <br /> ❑ D003 Reactive Cyanides based on 261 23 (a)(5) <br /> ❑ D003 Water Reaetives based on 261 .23(a) (2),(3) and (4) managed in non� CWA/non-CWA-equtvalenttoon Class I SSOWA <br /> Systems <br /> ❑ D003 Water R,eactives based on 261 . 23 (a)(2); (3 ) and (h) managed in CWA/ CWA-equivalent/Class I SMVA systems <br /> ❑ D003 Other Reaetives based on 261 .23 (a)( 1 ) <br /> If D004"43 boles are chacked complete and attach Form UC to address underlying hazardous constituclits (wiless these wastes Q!'e to be <br /> managed in C(4rsJ/C 61j}!_carr+valer:t/Clr7ss I SD1I,.4 systems) : <br /> ❑ D004 Arsenic ❑ DO05 Barium M D006 Cadmium ❑ D006 Cadmium containing batteries <br /> ❑ D007 Chromium ❑ D008 Lead ❑ D008 Lead acid batteries <br /> © D009 High mercuiT inorganic (>260 ma/kg total ). Including incinerator residue and residues from, RMERC <br /> © D009 T4'ft,mercury organic (>260 mglkg total); not including incinerator residue <br /> ❑ D009 Low-Mercury (%e'?5O mg(ka total) 0 D009 All DO09 Wastewaters <br /> c] DOI0 Selenium ❑ DO ) I Silver <br /> © D012 Endrin ❑ D023 o"Cresol © D033 Hexachlorobatadiene <br /> ❑ D013 Lindane ❑ D024 nn-Cresol ❑ D034 Hexachloroethane <br /> ❑ D014 Methoxychlor © D025 P�Cresol ❑ D035 Methyl ethyl ketone <br /> d D015 Toxaphene ❑ 11026 Cresols (Total) ❑ DO36 Nitrobenzene <br /> ❑ D016 2,4-D © DO27 p-Dichlorobenzene ❑ 13037 Peritttchloroplienol <br /> D017 2 ,4.5-TP (Siivex) ❑ D028 113-Dichloraethane M *0038 Pyridine <br /> DO18 Benzene ❑ 17029 I ,I .Di liloroethylene ElD039 Totrachloroetbylene <br /> D019 Carbon tetrachloride ❑ D030 2A4 Dinitrotolper+ c ❑ 1] 040 Trichloroethylene <br /> El D020 Chlordane ❑ D031 Heptachlor ❑ )) 041 294, 5-Tr1chlorophenol <br /> ❑ D021 Chlorobenzene ❑ D032 Hexachlorobenzene ❑ D042 2A.&Trichlorophenol <br /> ❑ D022 Chloroform ❑ D043 Vinyl chloride <br /> I <br /> Note: Ifany bolded entries are checked, form UC niust be completed to address underlying hazardous constituents, unless the material is <br /> treated in a Clean Wawr Act ( CWA) treatment process. <br /> hi addition. tl��fol ) mving �vasres :2-.included in this shipment' <br /> ❑ FOO [ � M Spent solvents, (If this box is checked. Complete the FOOI-FOV5 section p), the back of thisform. Cheek the h=oavdous waste <br /> numbers) that applies, and iderntif_tr the eonstitrrents likely to be pr•esetnt in the ti 0le.) <br /> If this shipment carries additional i wgte codes that aro not addressed above; identify them here: <br /> 1 <br /> SPA Waste Code aupcatcgory (if applicable) aA Waste _ode uubca ry (if applicable) <br /> Form .L',2.Re+isc+d 07)31/98 <br /> -� T/Iisl`�� t�vo.fldedltm <br />