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• S1r63=44747 SAFETY-X000RP. PAGE 1 OF 1 <br />LOR NOTIFI N FORM <br />GENERATOR NAME: ORCHARD HIS 05555 MANIFEST NO. ad R Z q6 <br />MANIFEST PAGEILINE# q 6` <br />NT TO 44 CFR 268.7(A), I HEREBY NOTIFY THAT THIS SHIPMENT CONTAINS <br />WASTE RESTRICTED UNDER 40 CFR PART 268 LAND DISPOSAL RESTRICTIONS (LOR). <br />A. GENERAL WASTE NOTIFICATION <br />EPA WASTE CODES & LOR SUBCATEGORIES (IF ANY) <br />DO01 LIQUID }= 10% TOC 0008 0018 <br />TREATABILITY GROUP: NONWASTEWATERS <br />WASTE CONSTITUENT NOTIFICATION: <br />LEGEND <br />NUMBER CONSTITUENT <br />------ ----------------------------------------- <br />154 ETHYL BENZENE <br />189 NAPHTHALENE <br />231 TOLUENE <br />245 XYLENES -MIXED ISOMERS (SUM OF 0-, M-, <br />AND P -XYLEM€ CONCENTRATIONS) <br />67 BENZENE <br />• <br />GENERATOR'S AUTHORIZED <br />SIGNATURE <br />S -k PROFILE REFERENCE NUMBER: <br />0 <br />NAME S TITLE <br />(PRINTED OR TYPED) <br />359498 9218 CONTROL NUMBER <br />DATE <br />2138380-7 <br />ff,.. <br />/?1If, <br />