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IeanHarbor Land Disposal Restriction Page : 1 of 1 <br /> Notification Form <br /> ENVIRONMENTAL SERVICES° Printed Date :Mar 03, 2017 <br /> _MANIFEST INF_ORM_A_TI_ON <br /> _ <br /> Generator City of Manteca <br /> I Manifest Tracking Info. <br /> Address: 1001 West Center Street <br /> Manteca,CA 95337 <br /> EPA ID#: CAL 0 0 0 0 9 5 9 9 6 Sales Order No: 17010808.401 G_ <br /> - -- ------ -- --- - -- ---- - -- - - -- '-- --- - -- - --- - -- ---- -- - <br /> LINE ITEM INFOR_M_ATIO_N__ __ __ _ <br /> Line Item: Tage No: TProfile No: Treatability Group: LDR Disposal Category <br /> ------ - - -- - -- ----- - - - - --- - <br /> - --- -- <br /> 1• I 1 1CH13123120 INON-WASTEWATER 10(Alternate Soil Std-does not meet std. <br /> (with characteristic hazardous waste only)) <br /> --- -- <br /> -J" ------ -- -- -------- - - - '- ---- -- - -- - - -- -- -- <br /> EPA Waste Code _ _ __ _ - -- -I EPA Waste Subcategory. _ __ _ __ _ __- - <br /> --- - - -- - - -- - -- --- - - <br /> D00a I Toxicity Characteristic for Lead <br /> Certification 1 Applies to <br /> circ. a.-(�. �-,t� .T.tvV I Manifest Line <br /> _ _ _ __ __ _ __ _ Iltams <br /> I certify under penalty of law that I personal)/have examined this contaminated soil and it does not contain-1. <br /> listed hazardous waste and does exhibit a characteristic of hazardous waste and requires treatment to <br /> meet the soil treatment standards as provided by 268.49(c). 1 <br /> - -- - - -T - --- - ------ -- - - - - - ---- ------------ -- I ------ <br /> Waste analysis data, ere avail is attached. <br /> Signature : _ _ __ S- Print Name <br /> Title: .-Date : <br /> - - - - - - -- 1 -- <br /> - - - ------ ---- - -- - - -- --- -- - - - - - - - - - ------- - - <br />