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LDR NOTIFICATION FORM Generator Name Lawrence Livermore Nattonal Laboraimy Manifest No. 005870075 11K Pursuant to 40 CFR §268.7(u), I hcreb notify that this shipment contains waste restricted under 40 CFR Part 268 Land Disposal Restrictions LDR A. GENERAL WASTE NOTIFICATION Form Line No. Profile No. EPA Waste Codes & LDR Subcategories (if anv) List codes or use Attachment I NWW WW Waste Constituent Notification Check the "None" box or list Legend Constituent # or use Attachnieat 2 I Transfer D006 ❑ ® -- � rl Check if Attachment I has been used ® None ❑ Check if Attachment 2 has been used 2 ❑ ❑ -- Check if Attachment I has been used ❑ None ❑ Check if Attuchment 2 has been used 3 ❑ ❑ ❑ None ❑ Check I I Attachment 2 has been used ❑ Check if Attachment I has been used 4 ❑ ❑ Check if Attachment I has been used ❑ None ❑ Check if Attachment 2 has been used 5 ❑ ❑ Check of Attachment I has been used ❑ None ❑ Check if Attachment 2 has been used 6 ❑ ❑ LJ Check if Attachment I has been used ❑ None ❑ Check if Attachment 2 has been used B. HAZARDOUS DEBRIS NOTIFICATION ❑ This hazardous debris, as identified above on Line No(s) is subject to the altemativc treatment standards of 40 CFR §268 45. The waste contains the following contaminants subject to treatment (check all that apply) ❑ Toxicity characteristic debris ❑ Debris cordaminated with listed waste ❑ Cyanide reactive debris C. CONTAMINATED SOiL NOTIFICATION & CERTIFICATION ❑ This contaminated soil, a, identified above on Line No(s) i, subject to the alternative treatment aandards of 40 CFR 4268.49(c) Complete the following: "I certify under penalty of law that I personally have examined this contaminated soil & it [E]docs/ [1does not] contain listed hazardous waste & [❑docs / ❑docs not] exhibit a characteristic of hazardous waste & [❑is subject to ! ❑complies with) soil treatment standards as provided by §268 49(c) or the universal treatment standards". Note Constituents subject to treatment are any constituents listed in 40 CFR §268.48 Universal Treatment Standards that are reasonably expected to be present in any given volume of contaminated soil. except luoride, selenium, sulfides, vanadium & zinc. & ore present at concentrations greater than ten times the universal treatment standard D. LAB PACK (INCINERATION) NOTIFICATION & CERTIFICATION ❑ Tltis lab pack, as identified above on Line No(s) is subject to the alternative treatment standards of 40 LI -R §268 42(c) "I certify under penalty of law that I personally have examined & am familiar wilh the waste & that the lab pack contains only wastes that have not been excluded under Appendix IV to 40 CPR Part 268 & that this lab pack will be sent to a combustion facility in compliance with the alternative treatment standards for lab packs at 40 CFR §268 42(c) I am aware that there are significant penalties for submitting a false certification, including the possibility of fine or imprisonment" E. EXTENSIONS & VARIANCES n This waste, as identified above on Line No(s) is not prohibited from land disposal & is subject to a deadline extension or vanance, e g , treatability variance, case -by case extension Describe below any extension or variance that applies to this x asie & inc ludo applicable dates Scott A Graham Shipping Coordinatot 01 / 07 / 2014 Generator's Authorized Si nature Name & Title(Ptinted or Typed) Datc nWALM M a0.NGTIFICATION t 111" RECEIVED JUL .14 2014 ENVIRONMENTAL HEALTH