COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

LDR NOTIFICATION FORM Generator Name Lawrence Livermore National Laboratory Manifest No. 005870989 JJK Pursuant to 40 CFR§268 7 a),I hereby notif that this shi mcnt contains waste restricted under 40 CFR Part 268 Land Dis osal Restrictions(LDR) A. GENERAL WASTE NOTIFICATION Form EPA Waste Codes Waste Constituent Notification Line Profile No. &LDR Subcategories(if any) NWW WW Check fire "None"hair or No. List codes or use Attachment I List Legend Constituent N or use Attachment T 11003 I EWSF ® ❑ Check if Attachment l has been used ®None ❑Check if Attachment 2 has been used 2 ❑ ❑ Check if Attachment I has been used ❑None ❑Check if Attachment 2 has been used 3 ❑ ❑ Check if Attachment I has been used ❑None ❑Check if Attachment 2 has been used 4 ❑ ❑ Check if Attachment i has been used ❑None ❑Check if Attachment 2 has been used S ❑ 11Check if Attachment I has been used ❑None ❑Check if Attachment 2 has been used 6 ❑ ❑ Check if Attachment I hasbeen used ❑Nonc ❑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 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 altcmativc treatment standards of 40 CPR§268.49(c) Complete the following: "1 certify under penalty of law that I personally have examined this contaminated soil&it[❑docs!❑does not]contain listed hazardous waste&[[]does I[]does not] exhibit a characteristic of hazardous waste& [[]is subject to 1[]complies with]soil treatment standards as provided by §268.49(c)or the universal treatment standards". Nate: Constituents subject to treatment are any constituents listed in as CFR J268.48 Universal Treatment Standards that are reasonably expected to be present in any given volume of contaminated soil, except fluoride,selenium,sulfides, vanadium&:inc,&are present at concentrations greater that ten limes the universal treatment standard. D. LAB PACK(INCINERATION)NOTIFICATION&CERTIFICATION n This lab hack.as identified above on Line No(s), is subject to the altcmativc treatment standards of 40 CI�R§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 ! F1 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 any extension or variance that applies to this waste&include applicable dater Scott A.Graham,Shipping Coordinator 02 ! 25 1 2019 Generator's Autharizcd Signature Name&Title(Printed or T cd) Date