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STATEWIDE ENVRaNMENTAL SERVICES; INC. <br />At. uN a -L..•; <br />.:.........., ... <br />LAND'DISPOSAi.xRFSTRI,CTION NOTIFICATION=` <br />INSTRUCTIONS: Complete Part 1. Check and complete Part II or Part Ill. Complete and sign Part IV. <br />PARTI Generator Profile and 'Manifest infortnation -1- <br />Generator Name: <br />RAYMOND 1 nJfS�mPfIT EPA ID �: �C001052136 <br />Address: 2245 W. CHARTER WAY-- -- —. <br />Profile Number: S26100- Manifest Number: y u�� �'�(r _ Line -Item Number: <br />PART11. . Waste` subject to Land Dis osafRestrictio <br />® Pursuant to 40CFR 268.7, 1 am notifying Statewide Environmental Services that under the above profile <br />number and manifest number, I am shipping to you a waste which is subject to the EPA Land Disposal <br />Restrictions, as checked below. <br />Mark one or more as applicable. <br />1.A wastewater identified by the EPA Waste Code/subcategory that I have checked in Part V; OR <br />�2.A non -wastewater identified by the EPA Waste Code/subcatergory that I have checked in Part V; OR <br />Q 3-A hazardous debris identified by the EPA Waste Code/subcatergory that I have checked in Part V. <br />Note: A wastewater is a waste that contains < 1 % by weight Total Organic Carbon (TOC) and <1 % by weigh <br />Total Suspended Solid (TSS). 40CFR 268.2 (d)(f) <br />Ca6fomis List Notification, if applicable <br />�4.A D001-DO11 waste which (a)_does (b)does not meet the definition of a 'California List' waste <br />(see definition below). If (a), I have also hecked the 'California List section of Attachment I, which I <br />am enclosing, Additionally, DO18-D043 apply it wastewater. <br />0 5.A nickel, thailium, FCB, or HOC 'California List' wasm (see definition below). I have checked the <br />'California List' section of Attachment I, which I am enclosing. Additionally D01 B -D043 apply if <br />wastewater. <br />Note: If any of the above California List Notifications were checked, identify ALL UNDERLYING HAZARDOUS <br />CONSTITUENTS in Section VI which can reasonably be expected to be present in the waste at a <br />concentration above the constituents - specific treatment standard listed in 40CFR 268.48. <br />Note: A 'California List' waste is (a) a hazardous waste containing Halogenated Organic Compounds (HOC) at <br />a concentration Z 1000 mg/kg or mg/I, or (b) a liquid hazardous waste having a pH < 2.0 and/or <br />containing any of the following materials at a concentration > that specified: PCBs, 50 ppm or (in mg/II <br />free cyanides, 1000; As, 500; Cd, 100; Cr (VI), 500; Pb, 500; Hg, 20; Ni, 134; Se, 100; TI, 130. <br />❑ 6.A specific extension or variance (other than a 'capacity variance extension'), as I have checked on Line <br />B or C of Attachment II, which I am enclosing. <br />7.The waste already meets all relevent treatment standards. I have signed the required certification page <br />of Attachment It, which I am enclosing. <br />8. Lab Pack. I have Signed the required certification page of Attachment 1, which I am enclosing. R <br />PART III : i wastescurranu 3' b `J` <br />•� • ••- _•- --- <br />Pursuant to 40 CFR 268.7, 1 am notifying Statewide Environmental Services that, under the above <br />profile number and manifest number, I am shipping to you a waste which is non-RCRA or <br />non -hazardous. The waste is not currently subject to EPA Land Disposal Restrictions because the waste <br />is non-RCRA or non -hazardous. <br />3 <br />� e � <br />