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STATEWIDE ENYRaNMENTAL SERVICE_ S, INC. LAND`DISPt1SAL`RESTRIGT)ON NC1TlFlCATIOW INSTRUCTIONS: Complete Part 1. Check and complete Part II or Part III. Complete and sign Part IV. [Address: 1.Generator Profile and`Man-lfest informationator Name: RAYMOND Tn JPruner+ EPA ID X: cAC001052136 2245 W. CEII�I'ER WAY- 95206STOCKTON State: CA Zip: e Number: Manifest Number: ��)G7� �c� Line Item Number: ..._ .u__•.c•} �'�a-11:�..n�nt Dn�}rir}tnniia 17.; }S. .. ❑ Pursuant to 40CFR 268.7, 1 am notifying Statewide Environmental Services that under the above profile number and manifest number, I am shipping to you a waste which is subject to the EPA Land Disposal Restrictions, as checked below. Mark one or more as appficable. ❑ 1.A wastewater identified by the EPA Waste Code/subcategory that I have checked in Part V; OR ❑ 2.A non -wastewater identified by the EPA Waste Code/subcatergory that I have checked in Part V; OR ❑ 3.A hazardous debris identified by the EPA Waste Code/subcatergory that I have checked in Part V. Note: A wastewater is a waste that contains < 1 % by weight Total Organic Carbon (TOC) and < 1 % by weigh Total Suspended Solid (TSS). 40CFR 268.2 (d)(f) Cafrfomia Ust Notifi ntkm, if applicable ❑ 4.A D001-DO11 waste which (a) does (b) does not meet the definition of a 'California List' waste (see definition below). if (a), I have also checked the 'California List section of Attachment 1, which I am enclosing. Additionally, D018 -D043 apply if wastewater. ❑ 5.A nickel, thallium, PCB, or HOC "California List" waste (see definition below). I have checked the 'California List' section of Attachment I, which I am enclosing. Additionally D01 B -D043 apply if wastewater. Note: If any of the above California List Notifications were checked, identify ALL UNDERLYING HAZARDOUS CONSTITUENTS in Section VI which can reasonably be expected to be present in the waste at a concentration above the constituents - specific treatment standard listed in 40CFR 268.48. Note: A 'California List' waste is (a) a hazardous waste containing Halogenated Organic Compounds (HOC) at a concentration 2 1000 mg/kg or mg/I, or (b) a liquid hazardous waste having a pH < 2.0 and/or containing any of the following materials at a concentration > that specified: PCBs, 50 ppm or (in mg/1) free cyanides, 1000; As, 500; Cd, 100; Cr (VII, 500; Pb, 500; Hg, 20; Ni, 134; Se, 100; TI, 130. ❑ 6.A specific extension or variance (other than a 'capacity variance extension'), as 1 have checked on Line B or C of Attachment Il, which 1 am enclosing. ❑ 7.The waste already meets all relevent treatment standards. 1 have signed the required certification page of Attachment it, which I am enclosing. ❑ S.Lab Pack. I have Signed the required certification page of Attachment 1, which I am enclosing. PART 111: >: Wttstes'currentl NOT'sub'ect'to Land Disposal Restrictions Pursuant to 40 CFR 268.7, 1 am notifying Statewide Environmental Services that, under the above profile number and manifest number, I am shipping to you a waste which is non-RCRA or non -hazardous. The waste is not currently subject to EPA Land Disposal Restrictions because the waste is non-RCRA or non -hazardous. PART Signatures Title: Print Or Type Name: R M