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!'r A TCU/I n <br />3V[CES, tNC.. <br />xTlnfu ?' <br />INSTRUCTIONS: Complete Part 1. Check and complete Part II or Part III. Complete and sign Part IV. <br />PART L Generator F <br />Generator Name: RAYMON <br />Address: 2245 W <br />City. r1STCJCKT <br />Profile Number: _Q.pL <br />nifest <br />om <br />Manifest Number: <br />EPA ID X:. <br />CA <br />CAC001052136 <br />Zip: <br />Pursuant to 40CFR 268.7, 1 am notifying Statewide Environmental SlrvicePthat 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 eppficable• <br />1.A wastewater identified by the EPA Waste Codelsubcategory 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 />® 3.A hazardous debris identified by the EPA Waste Codelsubcatergory that I have checked in Part V. <br />Note: A wastewater is a waste that contains < 1 °,6 by weight Total Organic Carbon (TOC) and < 1 % by weigh <br />Total Suspended Solid (TSS). 40CFR 268.2 (d)(f) <br />Ca6fomia List Notification. if applicable <br />U4.A D001 -D011 waste which (a) does (b) does not meet the definition of a 'California List waste <br />' (see definition below). If (a), 1 have also checked the 'California List section of Attachment 1, which I <br />am enclosing. Additionally, D018 -D043 apply it wastewater. <br />❑ 5.A nickel, thallium, PCB, or HOC 'California List' waste (see definition below). I have checked the <br />'California List' section of Attachment I, which 1 am enclosing. Additionally D018 -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 > 1000 mg/kg or mg/l, 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/1) <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 />Q 7.The waste already meets all relevent treatment standards. 1 have signed the required certification page <br />of Attachment Il, which I am enclosing. <br />B.Lab Pack. I have Signed the required certification page of Attachment 1, which I am enclosing. <br />PART Ifl. Wastes'currantl ' NOT 'subject to:Land 'Disposal Restrictions <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 />PARTIV: Authorized Re resen five 7n e1_ r/ <br />