Laserfiche WebLink
STgTE1N1QE ENVIRONMENTAL. SERVICES,, INC, <br />t et,lr�'nf��Ci 4t' RESTRICt1DN NOTIFICATION' <br />INSTRUCTIONS: Complete Part I. Check and complete Part II or Part III. Complete and sign Part IV. <br />PART ( Generator Profile and Manifest lnformatlom <br />Generator Name: <br />RAYMOM TnJcs�mea-� EPA ID �: CAC001052136 <br />Address: 2245 W. CHARTER WAY — . 95206 <br />City. STOCKTON Sta : Zip: 11� <br />Profile Number: ln '_ Vanifest.Number. Line Item Number: <br />El Pursuant to 40CFR 268.7, 1 am notifying Statewide Environmental Seivices that under the above profile <br />number and manifest number, 1 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 sppfcable• <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 />❑ 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 />CeAfornia List Notification, if applicable <br />4.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 I, 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 I am enclosing. Additionally D018-0043 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/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/I) <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 It, which I am enclosing. <br />7.The waste already meets all relevent treatment standards. I have signed the required certification page <br />of Attachment II, which I am enclosing. <br />❑ 8.Lab Pack. I have Signed the required certification page of Attachment 1, which I am enclosing. <br />pART Ill; '; Wastes currentl NOT subject to Land Disposal Restrictions <br />C] 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 />onor nr. i°, :..Authorized- Representative. <br />Signature: N ILBUR RAYMOND Tide: <br />P,;,,r nr Tvne Name: <br />