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CleanHarbors Land Disposal Restriction Page 1 of 1 <br /> Notification Form <br /> ENVIRONMENTAL SERVICES° — — — — Printed Date :Mar 03, 2017 <br /> MANIFES_TINFO_RMATION— — - - - - - - - - - - - - - - - - - <br /> - - - - - - -- - - - - - - - - - - <br /> Generator City of Manteca <br /> 7 Manifest Tracking Info <br /> Address: 1001 West Center Street <br /> Manteca,CA 95337 I D1 5 1 �1 ) /n <br /> I Q l(/ <br /> EPA ID#: CAL 0 0 0 0 9 5 9 9 6 Sales Order No: 1701080820 <br /> ------- ---------- - - --- -- --- --L--- --- - - - - - - - - - - <br /> LINE ITEM INFORMATION _ __ —— — — _ — _ <br /> Line Item Page No: Profile No: Treatability Group: I LDR Disposal Category <br /> -- --- - <br /> 1.--- -- j------ H13123128 — +ON-WASTEWATER - -- - -- -- --- - ------ - <br /> 10(Alternate Soil Std-does not meet std. <br /> _i————_—-L — ———— —L — —— —— — (with characteristic hazardous waste only)) <br /> EPA Waste Code - ---- --- -- - -_ — _-- - <br /> - - - - - - - - ---- -- -- - - --- - - - -- -- - � EPAWasteSubCategorY_ -- - - - - - - - - <br /> D008 I Toxicity Characteristic for Lead <br /> -- - -- -- - -- ' <br /> ----- -- --- - - - - - <br /> Certification 7� <br /> I 8poliManifest <br /> s to <br /> o¢ M� I Manifest Line <br /> '--- - - - - - - - - - - - - -- - �__ _ _ _ __ ) -litems <br /> I certify under penalty of law that I personally have examined this contaminated soil and it does not contain+. <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). I <br /> - -- ---- - ---- - -- -- - --- - -- <br /> Waste analysis data, ere avail a_is attached. —— —— ——— —I — — — — — — <br /> Signature : _ Print Name r S <br /> Title: Date: <br /> --- - - - --- ----- - -- ---- ------- ------- -- ----- ---- --- - - <br />