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05/23/2011 MON 15: 55 FAX 209 667 1126 Blackmun Equipment ®012/029 <br /> HUG-03-20011(TUE) 04: 11 P. o02/on3 <br /> Land Disposal Notification and Certification Form <br /> �1 Evergreen tail, Inc. <br /> 6880 Smith Ave. <br /> rk, CA 94560 <br /> ✓/ Phone(510) 795-4400 <br /> EPA 10 #CAD980887418 <br /> Generator Name: / .ei.5e071- <br /> Uniform Hazardous Waste Mani'fest#7 60Gc <br /> U.S. EPA ID Number. e, <br /> Applicable Altemadve Tmaanent SmdaMs <br /> Manitost Profile# RCRA Waste Codes NWWM/W Subcategory conetminaled tlaiardaba Lab Pack <br /> Lina# (1) (2) Sou Dabrispl <br /> 9b.1 — <br /> 9b.2 <br /> 9b.3 <br /> 9b_4 <br /> 1. wW-Wastewotorr wootoa that contain kas than 1%by weloht total arganle carbon ane Iona than t%by welght fatal swponded sotlds;NWW-Non- <br /> Wallewatera:vmates that do not meet the dotlnluon of wastovratem <br /> 2, For rZCRA wastes Codas 0001,DOM,D0os,0003,and D1309,died[appmprialo subcvtagory from list below. For all athor RCRA wgctg codas onter <br /> 'NONE <br /> 3. Thlswaste Is h=rdous debrb and Is sublect to the troalmont standards In 40 CFR 2Gs,45. <br /> Waste Subcategaries <br /> 9b.1 9b.2 9b.3 9b.4 S1lBC6TEGORY <br /> ❑ ❑ ❑ ❑ 0001-Ignitable Characteristic Wastes, except for the§26121(a)(1) High TOC Subcategory. <br /> (� ❑ ❑ ❑ 0001 -High TOC Ignitable Characteristic Liquids,Greater than 10%total organic carbon (does <br /> not apply to wastewaters) <br /> ❑ ❑ ❑ ❑ 0003-Reactive Sulfides based on 26123(a)(5) <br /> ❑ ❑ ❑ © D003-Other Readlves based on 261.23(a)(1) <br /> ❑ ❑ ❑ ❑ 0003-Water Reactive based on 261.23(a)(2), (3)and(4), (does not apply to wastewaters) <br /> ❑ ❑ ❑ ❑ D003-Reactive Cyanides Lased on 261.23(a)(5) <br /> ❑ ❑ ❑ ❑ 0006-Wastes exhibiting the'characterlslto of toxicity,far cadmium based on the TCLP <br /> ❑ ❑ ❑ ❑ 0006-Cadmium Containing 9atteries <br /> ❑ ❑ ❑ ❑ DOOR-Wastes exhlblting the characteristic of toxicity for lead based on the TCLP <br /> ❑ ❑ ❑ ❑ D008-Lead AcId flatteries <br /> ❑ ❑ ❑ ❑ D009-Non-wastewaters that exhibit the characteristic of toxicity for mercury and contain greater <br /> than or equal to 260 mglkg organic mercury <br /> ❑ ❑ ❑ ❑ D009-Non-wastewaters that exhibit the charaderlstic of toxlclty for mercury and contain greater <br /> than or equal to 260 m91k9 Inorganic mercury <br /> ❑ ❑ ❑ ❑ D009-Non-wastewaters that exhibit the characterisltc of toxicity for mercury and contain less <br /> than 260 mg/kg total mercury and that are residues from RMERC only <br /> ❑ ❑ ❑ ❑ 0009-Non-wastewaters that exhibit the Gharacterlsltc of texlclty for mercury and contain less <br /> than 260 mg/kg total mercury and that are not residues from RMERC only <br /> ❑ ❑ ❑ ❑ 0009-All D009 wastewaters <br />