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LAND DISPOSAL RESI*ICTION NOTIFICATION <br /> Manifest Manifest Manifest <br /> Line# Approval# Line# Approval# Line# Approval# <br /> Stoll 27b2 2747 <br /> Pacific 3150 EAST PICO BLVD. 9b2 2743 27b8 <br /> LOS ANGELES,CA 90023 9b3 27b4 27b9 <br /> Resource <br /> PHONE: 800.499.7145 <br /> Recovery FAX: 323.780.0078 gtoq 2745 274102741 27b6 <br /> This notification form shall be completed by the generator and shall accompany each shipment of restricted waste subject to <br /> the Land Disposal Restrictions (40 CFR 268 Subpart C). <br /> > Complete all information in Section I. <br /> > Check mark all appropriate Regulated Constituents in Section 11, additional applicable Sections and/or complete Section III. <br /> > Sign and date Section IV. <br /> SECTION I <br /> GENERATOR'S NAME J & H Marine Repair N <br /> OV 13 2014 <br /> EPA I.D.NUMBER CAC002792087 <br /> MANIFEST NUMBER 012917986JK ' 7 AL HEALT <br /> TREATABILITY GROUP Check one) I ..Wastewater F Non-Wastewater <br /> HAZARDOUS DEBRIS F Yes X, No <br /> EPA HAZARDOUS WASTE CODE(S)- <br /> D001 D018 <br /> rX There are no underlying hazardous constituents of concern,or <br /> There are underlying hazardous constituents of concern which do not meet the treatment standards of 40 CFR 268.48,Table <br /> UTS-Universal Treatment Standards(see Section 11). <br /> I have used the following to make the above determination: <br /> X Knowledge of the waste producing process, raw materials used and reaction products, or <br /> F Results of analysis for the constituents in Table UTS. <br /> Waste analysis data attached? [_ Yes No <br /> NON-RCRAWASTE LIQUID F SOLID (Check all that apply) ❑9bl ❑9b2 ❑9b3 9b4 <br /> Effective 1/31/96- ❑ <br /> Pursuant to Section 25179.6 of the Health and Safety Code,NON-RCRA ❑other(27bl-27b10) <br /> aqueous and solid waste containing organics has been repealed from <br /> Land Disposal Restriction Notification requirements. <br /> UNIVERSAL TREATMENT STANDARDS <br /> SECTION II <br /> The Underlying Hazardous Constituents must be identified for waste streams which carry the EPA Waste Codes F001-F005,F039,D001(only DOol <br /> not treated by RORGS,CMBST or POLYM),D005-D043(only D005-DO43 if treated in Non-CWA,Non-CWA equivalent or Non-SDWA facilities). <br /> The wastes identified on the aforementioned manifest document number and bearing the EPA Hazardous Waste Number(s)identified in Section I are <br /> subject to the Land Disposal Restrictions of 40 CFR 268 Subpart C.The wastes do not meet the applicable treatment standards specified In 40 CFR 268 <br /> Subpart D or exceeds the applicable prohibition levels specified in 40 CFR 268.32(California list wastes)or RCRA Section 3004(d).In compliance with <br /> the requirements of 40 CFR 268.7 and 268.9 we are indicating below the applicable constituents of concern. <br /> an re,mnnry-,y_o P84e 1 of4 <br />