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LLN L-AR-808080 LDR NOTIFICATION FORM Generator Name Lawrence Livermore National Laboratory Manifest No. 019445588 JJK Pursuant to 40 CFR$268 7(a).1 hereby notif that this shipment contains waste restricted under 40 CFR Part 268 Land Dis oral Restrictions(LDR) A. GENERAL WASTE NOTIFICATION Form EPA Waste Codes Waste Constituent Notification Line Profile No. &LDR Subcategories(if any) NWW WW Check the 'None"box or No. List cotles or use Altachnient I List Legend Constituent#or use Attachment 2 _DUU3E\,0008 1 DOPU138�1-1 ® ❑ ❑Check if Attachment I has been used ❑x None ❑Check if Attachment 2 has been used 2 ❑ D ❑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 1 has been used ❑None ❑Check if Attachment 2 has been used 5 ❑ ❑ ❑Check if Attachment 1 has been used ❑None ❑Check if Attachment 2 has been used 6 ❑ [] ❑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 subiect to the alternative treatment standards of 40 CFR 4268 45 The waste contains the following contaminants subject to treatment(check all Ilial 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;: "1 certify under penalty of law that I personally have examined this contaminated soil&it[[]does/❑docs not]contain listed hazardous waste & 10does 1❑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". Note: Constituents subject to treatment are any constituents listed in 40 CFR§168,48 Universal Treatment Standards that are reasonably expected to be present in any given vohnne of contaminated soil, except fluoride, selenhim, sulfides, vanadium cot Linc,c&are present at concentrations greater titan ten tinfes the universal treatment standard D. LAB PACK(INCINERATION)NOTIFICATION&CERTIFICATION n This lab Dack,;Ls identified above on Line No(s). is subject to the alternative treatment standards of40 CFR§268 42(c). "1 certify under penally of law that I personally have examined&am familiar with the waste&that(lie lab pack contains only wastes that have not been excluded larder 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). I 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 Linc No(s). is not prohibited Isom 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 haste c&include applicable dates: Scott A.Graham,Shipping Coordinator 12 1 06 1 2019 Generator's Authorized Srwnaturc Name&Title(Printed or Typed) Date MALI:ER.LDR NOTIFICATION 112199