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cro§bY &*VeAon <br /> Environmental Services <br /> LAND DISPOSAL RESTRICTION NOTIFICATION FORM (LDRNF) <br /> For Wastes Subject to the Treatment Standards Found in 40 CFR 268 <br /> INSTRUCTIONS: Complete Part 1,check and complete Part II. Complete and sign Part-M,if applicable. <br /> PART 1. Generator Reference and Manifest information C�D9g250�32.51 <br /> Generato <br /> rName: unified Western Grocers EPAI-D.# <br /> Address: 1990 Piccali P3. City: toe ton <br /> State: C k Zip_ 95215 Manifest Number: 00r}2 5009 <br /> This stream is(check one)_wastewater(Per Section 40 CFR 268.2(#)(1)(2)(3)) x'non-wastewater. <br /> PART U. Waste subject to Land Disposal Restrictions <br /> Pursuant to 40 GFR 268.7(a),i hereby notify that this waste shipment contains one or more of the following wastes)restricted <br /> under the land disposal restrictions for which applicable treatment standards are set forth in 40 GFR:,268.40 or 42 USSC, <br /> 6924(d). <br /> k <br /> EPA Hazardous Waste Numbers <br /> F listed Solvents(check all that apply) <br /> _F001 F002,F003,F004 or F005(Underlying constituents must be identified Use Form LDRN-IA) <br /> F005 Containing 2 Nitropropane or 2 Ethoxyethanol <br /> �F003-F005 COntainin carbon disulfide,cyclohexanone,methanol,or a combination of these oonstituents as the sole Fool-5 <br /> regulated constituent <br /> I <br /> Other Wastes <br /> Wastewatcror C&-0Pmfilc licablc <br /> List all l]�.lCl7 or P Subcategory App <br /> Codes(if any) (if any) See ?don-wastewater Number California Codes <br /> Ml,Do03,ctc- LMN-IB WW NWW <br /> I <br /> D001 x 51192' 343 <br /> i <br /> Hazardous Debris Notification �� <br /> _'this hazardous debris is subject to the,attc=bYe tnmt ment standards of 4D(:M 26$.45 <br /> I Confuninants subject to tee t(please list waste rodes.appiicabic to the debris) <br /> I <br /> j FACII rrY: Nate that"Contaminants Subject to Trcatrnmt"are those constituents applicable to a waste code fisted above for which a l3DAT ttnatment standard <br /> established in 40 CFR,268-40,including undr-dying eonstitacn,ts whcrc applicable. <br /> 1 <br /> I <br /> 1 i of5 <br /> 1610 West 17th Street,Long Beach,California 90813 <br /> (562)432-5445 (800)8 CROSBY FAX(562)436-7W <br />