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CleanHarbo'r% Land Disposal Restriction Page 1 of 1 <br /> Notification Form <br /> ENVIRONMENTAL SERVICES' Printed Date :Mar 03, 2017 <br /> MANIFEST INFORMATION - <br /> -- - - - -- - - - -- <br /> Generator: City of Manteca I Manifest Tracking Info. <br /> Address: 1001 West Center Street <br /> Manteca,CA 95337 ; 615,11 '91666 <br /> - <br /> EPA ID#: CAL 0 0 0 0 9 5 9 9 6 Sales Order No: 1701080820 <br /> - --- - -- - - --T- - - -- - --- - -- ---------- -- - - - - - - ---- -- - - - <br /> _LI_NEIT_E_M INFOR_M_ATIO_N__ _ _ _ _ __ _ _____ _ _ _ ____ ___ ____ _ ___ __ <br /> Line Item Tp No: T Profile No: Treatability Group: I LDR Disposal Category <br /> 1• - + - +CH13123126 -+NON-WASTEWATER -110(Alternate Soil Std-does not meet std. <br /> I I I I(with characteristic hazardous waste only)) <br /> - 1 - -- -- - L-- - - -- -1------ ------ - ---- - - - - - - - - - <br /> EPA Waste Code - - __ __ _- - - EPA Waste SubCategor- _ -- _ _ _ _ _ __ _ <br /> - - - - - -- - --- - -- --- - - - <br /> D008 I Toxicity Characteristic for Lead <br /> --- - - -- - - - -- - ---- --- - - ------- ----------- - - -r <br /> Certification J' _ � I Applies to <br /> "`1"`"�" ') 1Mltemsest Line <br /> L _ _ _ __ _ _ � _ ___ ____ ____ _________ _ _ 1 _ _ _ _ __ <br /> I certify under penalty of law that I personally have examined this contaminated soil and it does not contain 11. <br /> listed hazardous waste and does exhibit a characteristic of hazardous waste and requires treatment to I <br /> meet the soil treatment standards as provided by 268.49(c). I <br /> - -- -- --- ---- - ---- ---- --- -- - - -- - -- ----- - - - - -- - ----- <br /> Waste analysis data, ere avail is attached. I <br /> Signature: _ w_-_——__ Print Name <br /> Title : /Sc en- JCLM I�c�� -Date � -- ----- <br /> - - - - - - -- - -- --------- - -- - - --------------- -- ------- -- <br />