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®VEOLIA LAND DISPOSAL NOTIFICATION AND CERTIFICATION FORM PHASE IV <br /> eemAorvmaxw.sFm,crs <br /> Page—/—of <br /> Generator Name: 'Se L,.A -sig Manifest Tracking No. z� ?Iq+ii I/, <br /> 1.if waste Isawastewater l¢ee 40 CFR 2662)place W lmM W the apploDbie md.(s) Profile# , <br /> 2.LADES WITN SUBCATEGORIES(place eppreptlaM Ie6ertram¢action 8 bebre eadl LOCK Nal applies)(See 40 CFR 2661.MIDO-) <br /> DO), <br /> —pp„eLupaNbetlelies _MGW Caldsn WN. —ADDSWWWRIURea _UIS,RID, <br /> _CNl Eppq N.TCC WOe Omwdc H9>ApRq^ _IIp31 Pme¢nes. _IWNMI-o ERCMo. _U2902,90 <br /> —0003 flexIM Ly Wye —DOWIRDlg.Hg>RPo _K%I Nol Pmom Ra. P9 HIrc1RMERCRaz. _U2a02.9 esb¢9alle <br /> _CW3Peaurve 6WfiR _OIYOWd<200n05 _KIEa Lo M,em Rax —P0321n b,wflm. <br /> =�WW.R rres LgA1BrEs _KIMNd RaR gA.. _PPRtn gMFACNm. <br /> _0003 VnMOdem9 _XWG3 w _NPW15 pgnlQ _Po32Nd Irc MERCK— <br /> _D]VONmR... _KDI —Po92Hi WM ERCRm. <br /> _OUw BanMea —KW9 Ce4fum 8uMale —K,1TIb . _U151 WRMERC Rez <br /> _RbeLO YC Bea. —vIS1WNOI PMERCflm. <br /> TNe subcategory br DO18-D043 wale is lrealeEin nanCWA/nonSOWAledlil f IUYess Ne following box b Mecketl:p Yreatetl in CWA/SDWA leciKv <br /> 3.COMMON CODES(Place appmNate le0e1 110111¢eclbn 6 Wb...,cope IM1N applies) <br /> OOL2 PoI2 P030 _P051 _POA —Plm _PAS —1006 _ADW _R000 RYO _RID —Poll —0012 MID _Sea <br /> —DOp1 =0005 —Dan _0007 —0006 _ODM _0010 _0011 _0012 _0013 —DOM —0015 _0016 _0017 —0018 _0019 <br /> —LOA _0.Y1 —1)002 _00A _DY9 _1)(211 CLOT —0091 _1)(26 —0.W —_M3] 0031 —0042 _0033 —0039 DWS <br /> _UW7 =0044 _—UM _007002 _U�iMO =UI01 _U1e17 =Na _U19 =UUUG -UU4 =Ulm =W13 =U22D _I@ _Uums <br /> ADDITIONAL CODE6 tEMef Wlrotles nd1Ua16fie0 above wNch are BaSodaleOwMM1 weYel _KW, <br /> C USEPAHALIDMOUGWA E S.TREATMENr8TAN0AR08 FOR HON4NMSEII BTATE6 INWCAIETHEfiHOW NUSTiNE WA57E BE <br /> GOORS) THEATMEH78TANDAROOi I.M430RSPECIREOTEC =GTBRAP"MV)RICABLE MMIADEOY ENTEgTHE OF R <br /> FROM BELOW <br /> TaldmM lleii,wUHCz menapeEin rcn4WA,aw MF03WFW.NyiryNmNwe COlellNema PPmf gwMMWd:kl.m:❑ <br /> nm ulKa arelTemN wm9a^enllaaawal.�oarea:Iwea,pos.I laeMYmed.d:Iwan ulKa oD•.^auxclm:IreNire4) <br /> TO YIaWldmal EPA wagadxm(al,um Uenyplamanyl MCNaxltlrelii Fare:❑M WualwPgemredYtleelyW mayuzemuM1gmcrybs of Nlsbml. <br /> T.SOLVENT CONSIINH475IFp1.F W 5)QxG,trete b Szcesel IeMIN s'AI MizC:mr Y epwi wNpAs_ <br /> _Amore _e.IMa^e _maaNl,mpba _Gwne^dwm. <br /> _Cvtm TNmq bMe _CM1hrabentere —OCresN _Clad[(mSp) <br /> _C7doMnmre _aOt Dter ¢pm _3£tlwryMaM _EDIDURA <br /> _ENN Wnzane _EMNetlpr —Isobulmd _MaeMlq <br /> _M.xNaremarge _MamN emNkala^v —MelnHlacWMxaml+ _HIIaEmrala <br /> _z-rmraproPa,w _PYrwm _rMmmlwmleywl. _Tduere <br /> _1,1.1 ThNomlMrc <br /> —Own 2TMIMwtlwna _1,1.2TfWYaro,1.221MWgeNars' _TkbbiaetlglmN <br /> _TMdwwwnollummneNam Nnes <br /> e, (GILDA d EPA N meruge Ne MR Wapram^mylwre ft.IM chllaro d.nl lmm me 1.CMdw6—YSW hWw.WTerellwe npulelary Wtlw DR,,pur <br /> vU G-wM W hwm0 b mW m Uwe amb QWmWd dre 40 CFR dlel)a¢1 <br /> A,w✓ REBTGI OWASTEREWIHESTRFATMEM <br /> TMz wage nual be bm1eE m Ne eUpYaMe OeeMeM daMarla aN kM iA 90 CFO PM 239.40. <br /> O Fp HeWa OeMs:Tiisl MPER4ablakMSIIANUredromzWe traeMwMelvYeNs pIdOCFRf69A5.' <br /> B.1 HESTPICIEO WASTE THFAIMEN7M PERFORMANCE STANOAr1p$ <br /> TttNNuMar Po^aIN^Ilaw Nall M1aw persofnAYexemi^an eM em lamilarwNM1 Na bealmeMletlxalcgyaMapemtionaNe treaMcnl process weE to wgrywllNsmnd tlm.&aM <br /> m my'nqu'uy of Nose Wfm'Nak Immedalely real:xasBAe fofeMaWrq Wa Fbm,elbn,I MYwe Ual Ne tlmbreN prcmaa M1azbeen opmledaMmeNMinetl pmpeAywaa lo¢mply <br /> wMNelrealmmldeMenls apetllmEin IO CFg2H.9pwidwul impmdssidedldknd Ne pmM1ibilW wads.l am axam Uw11Mm em dpNOram pe:alWa brsubriiAbge Ialm <br /> ceNliraliul.MCmdy MepossipdN ale fireeMFngl. meq.• <br /> R.2 (CEmIFICATW PEMWIllBYPNASEILT <br /> B3 GOOD FAIINAHOAIMLMCAL CERTIFICATION-FOR WCIRIOI T DOROAMCS <br /> 'I aeNNulMarPorv^IryamwlM1ellM1rvo parzo211y nemhatlagam hmdiw lbgw baeMml YCNidgryertlommlim dNe trealmeM pmcem umOlosucedl lNzmni�Ion.Bests <br /> yYgAry d IMm hdriAwls NsdW slaty IeaUgmlde Ms rola W ig Nla Nlomwlkn,I MOeva¢al Na nmweslewalel ogeNc mnafi W en6 M1ave Men beam0 b)wmMRlm unis ae <br /> aµdde]h20¢.92,TNb t.l Ma bean undk b OeWf Nermwaslaxalerolpankwnsllluwnv,haply MNn9usetl Md poad RdM1etlonsroanYyee mrovJl aomtlluenM.l vn aware <br /> Ilat Uwre ue d9nlfimM IroreXms M zudTMup a Idae mnidmllm,its W inA lM paWLNN of lire eM iingiwmanl.' <br /> BA <br /> MAMMRInOWASMMOORUMT TMQ FDAUNDFRLYINGNALJLMWMNS111 Mn <br /> '1 CeKKyuMttpenakyal4w Un11Mwesb M1ae been Yeeledha¢v.Earce wW Il,e rpulremenkold0 CFR3¢eA0 brn,mrelMlwsudaus W%mAatie TNs dxMrxlaNed wade <br /> eonMln uMMyl:g llazelEglse litems ll¢IreWIm NNerbeaOnenlb meal uniwmdlmalmm slzmleNalemeware dullMreareagNdmM penmdeaMwbndipgekhe <br /> mnllulkn,kduaill9 fiw PaasWTlNa Greene impA.arvrem.• <br /> C. RESMI=DWASTESU&*E TOAVAWANCE <br /> T,'¢wazle4weled aanalknNaapaaiN vaAarFe,atrealabiyry va�hn sve4ymae edens'vi,EnbrlMelleCliva Udledp'dJbllb^in C01ann6WWa. <br /> ❑ ForAssa:deus Wpfis:•Ilv's M1anNasMb4Y v4pd to Na eMmalWelmalmONstaMarJZINdOCFR 2E9.M`.' <br /> 0. RESTWCIEO WASTE CANBE UND O45Po¢EO WRHOUI FUgTHFRTHEATNEN7 <br /> 'I m:dly,ugerce^alrydmwlAal l INvaprsMaDy asvlvmt aIxIM^IaiNfW wIIM1 UM wnsro Nmugllarelyls eMRLM9 or Olwgb WwwME9e eldmwasle b vi0%n NumNlkalvna Nel <br /> Uq wnM com{eas wiN IM1e bemmenl alwAeld:spvAreL M 40 Cm PM 239 8abpv10.16eleve Nel Ne IrAwmedn I aubmilRtl h Ime,ucumk eM mmgde,l em aware Uwt m ere em <br /> agNfimN penYOes ld smmidnOalYm mnnGl{M.Y dNInp MApaaSbYNdaR^a NdIm11A5mYIIBM.• <br /> E WASTE NOTCvflRENRY BUBJEMTO PA11T2NflE6THCnONS <br /> iNa wazm R c nexN Men W etl wsam NM N M mmantly subkd b aay do CFA Pan Me%IAdbnx <br /> IIIen6r mrNNNa I {i UMaM aAs ea R egvmla.mme bmlphlly lawvka9a rots Wemutlan. <br /> agwum p <br /> GENERATOR COPY Pore" "D <br />