Laserfiche WebLink
i <br /> LAND DISPOSAL RESTRICTIONS(LDR) Page� 1 <br /> �iESLt]Ri NOTICE ANo CERTIFICATIO NN . of -- <br /> Generator Name l�� ��j � { � <br /> EPA I.D.No.: <br /> Manifest Tracidng No,Db'SOS Taste Stream Number„ <br /> 6rtiiast (2) .: . W Div t 13s h4ote s ' (4) <br /> �agdlin tferit Hazardous Wastb Codesa ` PT itivater Subcateg �; r {Nhierrdfy. Appllseb9�.. <br /> � E ®e' �n <br /> —iF <br /> 9B1 D001 WW <br /> AEROSOLS <br /> WW NWW <br /> WW NWW <br /> WW NWW <br /> WW MM <br /> WW NWW <br /> WW NWW <br /> WW NWW <br /> WW NWW <br /> Np/VW <br /> WW NWW <br /> WW NWW <br /> WW NWW <br /> WW tdylrlW <br /> A ?,UMM8 waste axles adowed on a single line it the same Infomration in Coturrats 3 a Fr;tar NA°tar aH HazaN Codes other than t7041-D043, PoOITFt 05, and F039, <br /> through 6 apprses io the waste code saL To W iugifonel waste codes complete a Contaminated Saes, Hazardous Debris, and Dec hacaeterized Waste: For these <br /> Hentap MR ConHnrrntbn Form t±ES DM? oas..tha t-1,age ti <br /> FW'FfnS ••• . L L� )t i elil= 'enter u ie nuffrO&W tale kaj <br /> Spent SohenWndetlyayl Harardoc$Cons�nent/F�g I as p,,,r,r Her;raga e«.,I��r crv,,,r.N,�c.....� �rasetntalion from�n <br /> (HESLDR3) and enter numefic mnsff uerd n:femru If one or more applicable Laachate�T. .,.....001 F� SpaiN ""Gre ruxeuyutg%orutia,enL u3g <br /> waste codes are F001,FoC2 F003,rf>aa,FPS,F039,or DQ01 D043 or it u H adlal-i3 (HESLDR3)or the d eTkal name(s),it you choose to use the loom <br /> ciurose to use HESLDR3,please place an T In the Box. you <br /> ���co an W In the Box In Color m 5 end complete H£SWR3 by <br /> a C'400 elther`VVW—Waslawater or 1JWW°—Non Wru Mier based on the waste ldedlYkV no constituents using the appmprtata ft fed Pagaus Item.H there are <br /> that Is beLng shWad, aoose quahg fdentf lca6on enter°NONE°In Cahmun 5 <br /> c Enter the Subcatagory(res)aM ambia to the waste mda(cues instructions for Table bCaffme rat bourne d amHE-pmv;ded on <br /> I and enter number.Supplemerdal <br /> Of Subcategories or 40 CFR 268 Q4 A numerical entry from the Table of Intuctim Eo4er0*-0 Ge ff �urnber M tine. <br /> form HESLDFA in the <br /> Suhcategorlies In the irrsbuctions Is accep ble.Lam blank or enter'NA'd there Sed Instructions W Addttfonaf 111110 11on <br /> is not a Subcategory. <br /> If you have a decharacterized waste,contamitfad Mil,hazardous debris,lab packs <br /> an a ipdon,or operate a veatmeril fan RY please refer 10 cettflimbons on HESLDR4 and enter <br /> (3) app rate�rdti�Standard, <br /> uretbea For as�rHti Yeicns <br /> (3)an r� <br /> d(1 Oa),HLOR4 must accompany HF.SLDM. <br /> (i) Waste Does W Wed rrgqe Tmebrent Standards.Thgs�s a wWed waste that does not meet the applicable treatment stan Subpart D of 40 dards set fcuth In <br /> CFR Part 2GB <br /> (2) Waste 14' Aonricabie Tmahnerd Sland��tds.I certify under penalty at law that 1 personally have examined and am familiar with the ar>R sisPa and testing or through edge of the waste to support ttds cedfftcation that the waste=npfras with the treatment standards coast$through <br /> CFR Part 268 Subpart D.I believe that the tnfoamdrxt I submitted�live, accurate end <br /> sabmiding a false c e ficatiarr,irxlu the mete. I am aware that there are significant penatties for ding possffifrdy of a fine and imprisonment, <br /> {certify that$8 irdorrnation i on this and any additional pages(HESWRfi i-ESLDR3,HESLDR4)of this LD no if ' n is true,accurate and comptele. <br /> Authorized Signature: P Pdnt or <br /> n <br /> CompanyflI te: � <br /> Dale; <br /> a7cW-ar7 tIs <br /> Ap,U 2007 <br />