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o fi ti L c Vvtl f ENVIRONMENTAL, SElwiKICES, INC: <br />CALIFORNIA LAND DISPOSAL RFSIMMON HOTIRCATION <br />PARC l: Generator Information. <br />GENERATOR NAME: RAYMOND <br />CAC001052136 3 <br />EPA ID N MANIF • N PROFILE ir <br />The waste(s) identified on the above referenced manifest zid bearing the Califdmti wore number(s) identified below is subject o the Lod Disposal <br />Restrictions of CCR, Title 22. Diviwn (n4.5. Chapter Ig 11 I1y, <br />PARI' II: Yhstc Identification, t�s41C)r � yv171\ Enc�a�l-� % •. . <br />California waste numbers) Q <br />Check the appropriate lines. (More than one line may apply.) <br />I. RCRA regulated waste, <br />2. PCB wastes identified in CCR, Title 22, 66268.100(&)(2), <br />3. Non-RCRA metal -containing solid waste identified in CCR, Tttle 22, 66268,100(8)(7). Prohibition efr=iw date January I. 1994. <br />4. Non-RCRA aqueous and liquid wane containing any organiccm poutd idents <br />8by F1aA'hst Methods 8080. 8144 8150, 8240. and/or <br />270 pursuant to CCR, Title 22, 66268.100(a)(10)• prohbbion effective <br />date, January 1, 1994 <br />5. Non-RCRA solid waste containing anyorganiccomim"A idemified by EPATest Methods gt)gp• M 8154 8240. and/orli=pummm <br />to CCR, Title 22, 66268.100(a)(11). Prohibition effective due jammry 1. 1996. <br />6, Other Non-RCRA, California regulated waste- Category includes remaining wades in 22 CCR 268.100(&) not listed above and warier <br />regulated pursuant o 22 CCR 66268.1(h). <br />PART III: Handling Method. <br />0.-eck the appropriate lines. (More than one line may apply.) <br />X 1. The RCRA waste identified above must be handled in accordance with the atacbed FPA LAND DISPOSAL RESTRICIION <br />NOTIFICATION. <br />2. The waste identified above must be treated to meet the applicable standards <br />in CCR, Tule 22, Division 4.5, Chapter Ill, Article 11. <br />3. The waste identified above meets the applicable «eztmem standard, <br />"I certify under penalty of law what 1 personally have examined and <br />knowledge of the wore to support this certificatam familiar with the wore through analysis and testing or through <br />Division 4.5. Chapter 18. Articles I and Il. 1 bion that the tote cnrrspiies with the treatment standards specified in CCR, Tule 22, <br />elieve that the information I st--bmitd is true, accurate, and complete I am &ovate <br />that there are significant penalties for submitting a false certification, includin; th c possibility, of a fine and imprisonment: <br />4. The waste identified above is subject to a variance. The expiration date of the wrianee is <br />(input the actual effective prohibition date from Part 11 above), <br />5. Tie Non-RCRA --zee Ad ntified above is nes currently; m rioted from land disposal. <br />PART IV: Generator Certification. <br />1 warrant that I am an authorized relamsenative of the generator. I certify under penalty of law that the waste complier with the im3umm standards <br />specified in CCR. Title 22. Division 4.5. Chapter 18. Section(s) 66268. 1 believe that the information I submitted is troe, accurate. <br />I am aware that there are siendicant penalties ! r submivin¢ a false certification, includingthe possibility Of fine and imson complete. <br />P� Y pri mem. <br />Signature: IA, , U • QGam_ <br />' t) true:'' <br />Print or T)pcc Name: W=UR RAYMOND ` <br />Talc <br />Nec I rtf I <br />