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LDR NOTIFICATION FoRm Generator Name Lawrence Livermore National Laboratory (Manifest No. 005870883 JJK Pursuant to 40 CFR 268.7(x).I hemb no J Fy that this shipment contains waste restricted under 433 CFR Part 268 Land Disposal Restrictions(LDR). A. GENERAL WASTE NOTIFICATION Form EPA Waste Codes Waste Constituent Notification Line Profile No. &L D R Subcategories(if any) NWW WW Check the "Norte"box or No. List codes or ltse Attachment 1 List Legend Constituent#or use Attachment 2 D011.D006 _ I DOP0013-1 ❑ I El Check if Attachment I has been used ®None ❑Check if Attachment 2 has been used D040r F002,DO 19 — 248,249,258,27,9,255 2 DOP0032-1 ® ❑ — " El Check if Attachment I has been used ❑None ❑Check if Attachment 2 has been used D008 3 DOP0036-1 ® ❑ Check if Attachment I has been used ®None ❑Check if Attachment 2 has been used D008 D006,DOI 1 4 DOP0036A-1 ® ❑ Check if Attachment I has been used ❑None ❑Check if Attachment 2 has been used 13001 LQ 5 DOP0054-1 ® ❑ Check if Attachment I has been used ®None ❑Check if Attachment 2 has been used D009 HM N1RR 6 DOP0071-1A ® ❑ Check if Attachment I has been used ®None ❑Check if Attachment 2 has been used B. HAZARDOUS DEBRIS NOTIFICATION n This hazardous debris,as identified above on Line No(s). is subiect to the alternative treatment standards of 40 CFR§268.45. The waste contains the following contaminants subject to treatment(check all that apply): ❑Toxicity-characteristic debris ❑ Debris contaminated with listed waste ❑Cyanide reactive debris C. CONTAMINATED SOIL NOTIFICATION&CERTIFICATION F1 This contaminated soil,as identified above on Line No(s), is subject to(lie alternative treatment standards of 40 CFR§268.49(c). Complete the following: "1 certify under penalty of law that I personally have examined this contaminated soil&it[❑does!❑docs not]contain listed hazarfous waste&[[]does/[]does not] exhibit a characteristic of hazardous waste&[0 is subject to/❑complies with] soil treatment standards as provided by §268.49(c)or the universal treatment standards". Note: Constituents stibfeci to treatment arc arty eorhslituenls listed in 4O CFR§268.43 Universal Treatment Siandards 11rat are reasonably expected to be present in ariv given Volume of contatninated soil,except fhtaride.selertiurn,sulfides, ranadiarn&--inc,&are present at concentrations greater than ten tirnes the universal treatment stmalarti. D. LAB PACK(INCINERATION)NOTIFICATION&CERTIFICATION This lab pack,as identified above on Line No(s). 7—It is subject to the alternative treatment standards of 40 CFR§268.42(c). "I certify under penalty of law that I personally have examined&am familiar with the waste&that the lab pack contains only wastes that have not been excluded under Appendix IV to 40 CFR Part 268 &that this lab pack will be sent to a combustion facility in compliance with the alternative treatment standards For lab packs at 40 CFR§268.42(c). 1 am aware that there are significant penalties for submitting a false certification,including the possibility of fine or imprisonment". E. EXTENSIONS&VARIANCES n This waste,as identified above on Line No(s). is not prohibited from land disposal&is subject to a deadline extension or variance, e.g.,treatability variance,case-by-case extension. Describe below arry extension or variance that applies to this waste&inchrde applicable tidies: A< Scott A.Graham,Shipping Coordinator 11 / 01 1 2018 Generalor's Autltnnzcd ' nature Name&Title(Printed or Typed) Dale aMALYFUDRM)TIFICA1101N.11 2199