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LeaqHarbor Land Disposal Restriction Page 1 of 1 <br /> Notification Form <br /> ENVIRONMENTAL SERVICESO Printed Date :Mar 03, 2017 <br /> MA_NIFES_T INFORMATION <br /> Generator City of Manteca 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: 1701080820 <br /> ------- -- ----- -- - ---- - -- -- --' - <br /> LINE ITEMINFOR_M_ATION ___ _ - - -- ---- - - - --- -- - -- -- <br /> -- -- -I-- - -- --- - - -- - - -- - -Line Item: Page No: Profile No: TTreatability Group: LDR Disposal Category <br /> 1 _+ - %H13123128 -+ON-WASTEWATER -I (Alt <br /> 10 emate Soit Std-does not meet std. <br /> I(with characteristic hazardous waste only)) <br /> — D- ------ L- ---- - 1- - -- -- -- '--- - --- - <br /> EPAWasteCode I_- - -- - - -- -- -- <br /> _ _____ _ _ _ ____ _ _ _ _ _ __ _, EPA Waste SubCategor� _ <br /> D009 - - - - - --- - - <br /> - - - -- -- - - --- -- ---- -- - - - - - - --- I Toxicity Characteristic for Lead- _ <br /> - ertifi ation 7 - <br /> 11 I Applies to <br /> j/ I Items Line <br /> I certify under penalty of law that I personally'have examilned 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). I <br /> - -- - - -- - - - - - - - - - ----- --- <br /> Waste analysis data, wpiere avail��,'\j el/ is attached. <br /> Signature : __,� L=�`-'-'_'=T Print Name <br /> Title : /.�_ -j M :v <br /> --Date: <br /> --- - - - -- - -- - -- --- - -- - --- - -------------- - - - - - - - - - - <br />