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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 INFORMATION_ __ _ _ _ _ _ _ _ _ _ _ __ _ _ <br /> Generator City of Manteca <br /> I Manifest Tracking Info. <br /> Address: 1001 West Center Street o� <br /> Manteca,CA 95337 b15q ?I � 5 )J K <br /> EPA ID#: CAL 0 0 0 0 9 5 9 9 6 Sales Order No: 1701080820 <br /> - --- --- - - --------- - ------ <br /> --- -- ------- - - - - - -- -- - - - - -- -- <br /> LINE_IT_E_M INFOR_M_ATIO_N__ _ _ __ _ <br /> Line Item TPage No: Profile No: Treatability Group: I LDR Disposal Category <br /> 1• —+ —-cH1312312B —+NON-WASTEWATER — 10(Altemate Soil Std-does not meet std. <br /> I I I I(with characteristic hazardous waste onl <br /> ---- -- L - -- --- L-- - - - - L - ---- - - -7-- -- - -- -- - --- -- -y <br /> --- -- - -- -- - --- -- Y)) <br /> _EP_A_Waste_Co_de----- -- - - - - - - - - - - - - - - - I_EP_A_WasteSu_bC_ategory _ __ _ __ __ - - <br /> 0008 1 Toxicity Characteristic for Lead <br /> ---- --- - - ---- - - -- - - - - - - - - - --- - - —— — —— — ——— — — - <br /> Certification 1 Applies to <br /> — ——— e¢. Mr c,. t� g,T.- n�/V 1 Manifest Line <br /> I I lam;: <br /> r I certify under penalty of law that I personally have examined this contaminated soil and it does not conte tm . <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). l <br /> •- -- ---- - ------- - - ----- --- - - - - ---- ----- --- -- I --- - - - <br /> Waste analysis data" avail is attached. <br /> Signature : ! 4_+t_— ___. Print Name <br /> Title : /-- .ra � M I�_Date : 4 <br /> - ---- - - - - -- --- ---- -- ----- - -- ---- - ----- - - ----- -- -- -- <br />