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IeanHarbor Land Disposal Restriction Page : 1 of 1 <br /> Notification Form <br /> ENVIRONMENTAL SERVICES° Printed Date :Mar 03, 2017 <br /> _ ® _ - _ _ _ _ _ _ _ - --- ----- - ----- - _-- --- - - - _ - --- - - <br /> _ _ _ _ _ _ <br /> MANIFEST INFORMATION _ <br /> - <br /> - - - -- -- - - - - - --- <br /> Generator: City of Manteca 7 <br /> I Manifest Tracking Info. <br /> Address: 1001 West Center Street <br /> Manteca,CA 95337 <br /> EPA ID#: CAL000095996 - -Sales Order No: 1701080820 - - - - <br /> L -- --- -- --- ---- - ---- - -- -- --- - <br /> LINE ITEM INFORMATION __ __ <br /> -- - -- -- --- - - - - - - - - - - - <br /> Line Item: Tags No: �Profile No: <br /> -IT Group: I LDR Disposal Category <br /> ---- -- --- -- <br /> 1. I 1 H13123128 - +ON-WTE <br /> ASWATER -I 10(Alternate Soil Std-does ot <br /> nmeet std. <br /> —EFA <br /> _ _ _ i _ __ -_ _ y -- _ _ -_L_- - -_-- I(with characteristic hazardous waste only)) <br /> _ - - -- --- - - <br /> EPAWasteCode- - --- -- ---- -- - - - - - - -- - I_EP_AWasteSubCategory. - _ - - - - _- -_ _ <br /> D008 I Toxicity Characteristic for Lead <br /> - -- ----- ------ -------- --- --- - -- --- - - -- --- - - -T— <br /> Certification 1 Ann ies to <br /> I Manifest Line <br /> I Items <br /> I certify under penalty of law that I personally have examined this contaminated soil and it does not contain I I. <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 /> - -- - ---- ------ - -- - -- -- - -- ---- ------ -- - - - - - -I - -- -- - <br /> Waste analysis data, ere aveillt is attached. <br /> Signature Print NameyL <br /> Title: ",- . -I " J t4-y�- Date <br /> - - - - - - -- ---- --- -- --- - - --- --- --- --- - -- -- --- - - - --- --- <br />