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_ -- <br /> CleanEarffa <br /> Land Disposal Restriction Notification <br /> G,:neratorNamw UReiliyAuto Parm#M10 EPA Number. CAU40w1. M35 <br /> 0 aerator Address-, 1551 WEST UAIM STREET RIPON. CA <br /> Manifest Tracking Number. 200108905CLZ <br /> Instructions <br /> tiolumn is Last the Manifest Line rwmber or Manifest Line gem. <br /> Column 2:Identify all U-S.EPA hazardous Waste Codes that apply to this Shipanenl. <br /> I:olumn 8:Chome the appropMe treatability gawp_Non-YVastenwater(N W)or WasleArAer{ ). <br /> ..=olumn 4:Enter Me Wopriale Subcategory{per 40 GFR 268-40)_if appticahte,and also enter`Contaminated Soil'of-Debris"i#the w 5ke Will e <br /> .,'n8 qd using one of The Sftemath a treatment IechnDlagies provided by 268.49{c)-sail,or 258.45-debris- <br /> Cot,mn 5:Enter the letter of the appropriate paragraph from below(seae Appendix 1 for other 4p6ons if needed) <br /> :olumn 6: For FOO 1-FOOS,please enter the Reference Numbers)located below for the conslituents in your waste strum subject to treatment. <br /> Column 7, For F039,D001-13043, Debris&Contaminated Soil=please list the Reference{umbers IlSted Fn Appendix 2 for any Under#ying Hazardous <br /> Constituents. <br /> Chea One <br /> Urlderkyin9 Hrdous <br /> ✓�5enifest Line Nurrlber U-S_EPA Hazatdoua s Haw Must This Regulated I Constituents <br /> Manifest Line Item Waste Codes i Sub Calc Ory Waste Be Constituents for DOD1-CO43, <br /> x Man <br /> NW ; WW S Mangy? Fee FO41•F405 I febris or Scd <br /> --- _ _ <br /> 1OW70 DOO1 Yes j # High TOC Ignitable. A - <br /> --- ... Liquid — <br /> Column 5 Waste Management Codes <br /> A THISREST RICTEDWASTE REQUIRESTREAT MENT TCFTHE APPItCAB ESTANDARD.Tinsw®abemustbetreatedto <br /> the applicahis performance based treatment standard set forth in 40CFR Pan 268 Subpart C.26$-32 Subgdrl D,M3.40 or <br /> RCRA Section 3004(d)prior to lane Omposat. <br /> Column 6 FOOT-F005 Ref ere ace fdumbers <br /> ' Column 3 D001-DO43 Reference Numbers <br /> I `)ereby Certify that all tnforenalion subsuaibed at#his and all associated d ocu menta is com plete and accu rate to the besl of my k nowl$dge and <br /> information. <br /> CFenerator Signature, Tifla: <br /> Printed Mame: Datta, <br />