COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

California Land Disposal/Restriction information Notification/Certification Form This form is submitted in accordance with the requirements of 22 CCR 66268.7(a) Chapter 18 which restricts land disposal of certain hazardous wastes. The appropriate California waste code(s)and applicable non-RCRA hazardous waste listings from CCR 66268 28 are noted below.Complete all portions of Part I. If the waste is non-hazardous or not restricted,then complete only the applicable portions in Part I and sign i date the Form at the bottom of page. Otherwise complete Part I,II,and 111,and s€gnldate the Form at the bottom of page. I. GENERAL INFORMATION REGARDING GENERATOR&WASTE STREAM GENERATOR'S NAME Lawrence Livermore National Laboratory PHONE: 925422-1925 SITE LOCATION: Corral ifollow Road,Tracy,CA 95376 PROFILE NUMBER:_. _DOP0031-1 IS THIS WASTE NONHAZARDOUS?®NO, ❑YES(if YES,stop here and sigrl/dete form at the bottom of page) GENERATOR'S EPA ID#: CA289009002 MANIFEST#: 019445579,LIK CA WASTE CODE(S): 261.751 IS THIS WASTE RESTRICTED? []YES ®NO(if NO,stop here and sigNdate form at the bottom of page) THIS NOTIFICATION&CERTIFICATION iS BASED ON THE FOLLOWING WASTE STREAM INFORMATION: ❑(A)CHEMICAL/PHYSICAL ANALYSIS OF THE WASTE; ❑(B)GENERATOR KNOWLEDGE OF THE WASTE:OR ❑(C)BOTH Check the appropriate boxes in Parts II and III.If only one applies,theft IIIA)is not required.For multiple certifications/notifications,the appropriate choices from Part II(1-3)maybe marked In Part Ill(A)to indicate how waste is to be managed to conform with Land Disposal Restrictions By selecting an item in Part III(A) 1-3 you are making the certification 1 notification noted in Part II. It. TYPE OF LDR NOTIFICATION I CERTIFICATION ❑ 1.> NOTIFICATION ONLY: WASTES THAT CURRENTLY REQUIRE TREATMENT TO MEET THE 22 CCR ARTICLE 11 TREATMENT STANDARDS:=*22 CCR§66268.7(a)(1) ❑ 2.>NOTIFICATION&CERTIFICATION:WASTE THAT MEETS THE 22 CCR ARTICLE 11 TREATMENT STANDARDS,NO ADDITIONAL TREATMENT REQUIRED:=;�22 CCR 166268.7(aii2) I terrify under penalty of law that 1 personally have examined and am familiar with the waste through analysis and testing through knowledge of the waste to support this certification,that the waste complies with the treatment standards specified in CCR Title 22,Division 4.5,Chapter 18 Articles 4 and i 1 and all applicable prohibitions set forth In CCR Title 22,Section 66266.32 or RCRA Section 3004(d)(42 U S C.Section 6924(d)).I believe that the information I submitted is true,accurate and complete.l am aware that there are significant penalties forsubmitting a false certification,including the possibility of fine or imprisonment ❑ 3.>NOTIFICATION&CERTIFICATION: NON-RCRA WASTE THAT HAS BEEN TREATED AT AN OFF-SITE TREATMENT FACILITY SO AS TO MEET ALL APPLICABLE 22 CCR ARTICLE 11 TREATMENT STANDARDS:a 22 CCR 966268.71b)(5) i certify under penalty of law that 1 personally have examined and am familiar with the waste through analysis and testing through knowledge of the waste to support this certification,that the waste complies with the treatment standards specified in CCR Title 22,Division 4.5,Chapter 18,Articles 4 and 11 and all applicable prohibitions set forth in CCR Title 12,Section 66268.32 or RCRA Section 3004(d)(42 U.S C.Section 6924(d)).I believe that the information t submitted is true,accurate and complete.I am aware that there are significant penalties for submitting a false certification,including the possibility of a fine or imprisonment. 111.LDR NOTIFICATION/CERTIFICATION INFORMATION REQUIRED BY 22CCR Check tat tat ICI IDI appropriate Cheek 1.2or 3 from Corresponding bones handling Information Prohibition Subcategory of Restricted waste 122 CCR 6626829 a•ml and Treatment Standard (Part li) Effective Date Treatability Group(sl 66268,100Ia)11-14) lFrom 22 CCRI 1.❑ ❑1 ❑2 ❑3 1126190 Aqueous wastes containing metals 166268.29(x)&66260.1o0'al(111 1 66266.107 Table II CCW 2.❑ ❑1 ❑2 03 516191 Auto shredder waste 166268.29(c)&66268.100ja113il 2 66260.106 Table•A CCWE 3.❑ 01 ❑2 ❑3 1/1/91 Hazardous waste foundry sand 166268.29(e)&66268.100(a)(5)1 4 66268,106 Table 1.8 CCWE 4.❑ 131 ❑2 ❑3 1/1191 Fly ash,bottom ash,retort ash or baghouse waste 166268.29'h)&66268.100(a)(811 7 66266.106 Table I•D CCWE 5.❑ ❑1 02 ❑3 111191 Baghouse waste from foundries 166268.290)&66268.100(a)(9)l 9 65268.106 Table I•E CWE G.❑ ❑1 ❑2 ❑3 3!1193 Asbestos containing waste ideniitim in section[56268.291m)&66268.100(x)(1311 12 66268.114 7.El 01 ❑2 133 1 Otherispecifyl: 13 Copies of applicable treatment standards and waste analysis data(where available)are maintained at the facility identified on the manifest referenced above. IV. GENERATOR AUTHORIZATIONiCERTIFICATION I hereby certify that all Information submitted in this and all associated documents is true,complete,and accurate to the best of my knowledge and information,and that no omissions or errors a €;st. arrant that I am an authorized representative of the generator. SCOTTA.CRAHANI Shi in Coordinator 11/1312019 Authorized Signature Printed Name Title Date THIS DOCUMENT, W€TH AN ORIGINAL SIGNATURE, MUST ACCOMPANY EACH WASTE SHIPMENT. A COPY OF THIS CERTIFICATION, AND ALL SUPPORTING DATA,MUST BE RETAINED BY THE GENERATOR FOR A LEAST FIVE(5)YEARS AS PER 22 CCR§66268.7 Rev.11 M2 Page ') of 2