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LDR NOTIFICATION FORM Generator Name Lawrence Livermore National Laboratory Manifest No. 005870814 JJK Pursuant to 40 CFR '268 7(a)•[hereby notify that this shipment contains waste restricted under 40 CFR Part 268 Land Disposal Restrictions(LDR). A. GENERAL WASTE NOTIFICATION Form EPA Waste Codes Waste Constituent Notification Line CII Profile No. &LDR Subcategories(if any) NWW WW Check the 'Notre"box or No. List codes or use Attachment I List Leseud Constittient#1 or rise Attacltutent? DOI1,D006,D009 LNI NI RR _ I DOP0013-1 ❑ 10 ❑Check if Attachment I has been used ©None ❑Check if Attachment 2 has been used D005,DO08,DOI l 2 DOP0036-1 ® ❑ ❑Check if Attachment I has been used ©None ❑Check if Attachment 2 has been used DOI 1,D008 3 DOP0036A-1 ❑ ❑Check if Attachment I has been used ®None ❑Check if Attachment 2 has been used DOW L 4 DOP0054-1 - ® ❑ ❑Check if Attachment I has been used ®None ❑Check if Attachment 2 has been used D009[IN[NIRR 5 DOP0071-IA © ❑ ❑Check if Attachment I has been used ©None ❑Check if Attachment 2 has been used F002 6 DOP0077-1 ® ❑ ❑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 NoW, is subiecl to the alternative treatment standards of 40 CFR 6268.45. 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 n This contaminated soil,as identified above on Line No(s). is subject to the alternative treatment standards of 40 CFR§268 49(c) Complete the following: "I certify under penalty of law that I personally have examined this contaminated soil& it[E]does/❑does not]contain listed hazardous waste&[❑docs/❑does not]exhibit a characteristic of hazardous waste&[❑is subject to/[]complies with]soil treatment standards as provided by§268.49(c)or the universal treatment standards". Note- Constituents subject to treatment are any constituents listed in 40 CFR J268.48 Unrversal Treatment Standards that are reasonably expected to be present in any given volrurre of contaminated soil,except fluoride,selenium,sulfides %anadurnn&:Inc.&are present at concentrations greater than ten tunes the universal trealtnew standard. D. LAB PACK(INCINERATION)NOTIFICATION&CERTIFICATION rC]This lab pack,as identified above on Line No(s). 8- 11 is subject to the alternative treatment standards of 40 CFR§268 42(c) "I certify under penalty of law that 1 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 Part268&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). i am aware that there are significant penalties for submitting a false certification, including the possibility of tine or imprisonment". E. EXTENSIONS&VARIANCES n This waste,as identified above on Line No(s), is not prohibited from[and disposal&is subject to a deadline extension orvariance, e.g.,treatability variance,case-by-case extension. Describe below any extension or variance that applies to this uvaste&include applicable dates Scott A.Graham,Shipping Coordinator 05 I 21 1 2018 Generator's Authorized Si nxure Name&Title(Printed orTyped) Date OWALKER LOP NOTIFICATION 11 1199