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I an Ear hi- <br /> Land Disposal Restriction Notification <br /> G-erterator riEama, 99 Cents On ly#254 EPA Mimber: CALOpQ36W <br /> GeneNdOrAWYMS. 1441}4V.March Larne Slocktoo,CA <br /> Manifest Tr king Pumper_ 015630444FLE <br /> 1�}Slir~i�C�fdfrS <br /> Column 1:list the 14 wOest Line number Cr War3 rfest Line iwn- <br /> Column 2:Ida*Fy nU 1J-S.EPA Nwaird els WastD Codon that appWy to thin shipment. <br /> Colum 3:Chome tyre appropriate treatabiWygrcLFp:Non-Wastewater(MMV)ar Wastewatur MW). <br /> Column 4: (per 40 Cl=R ZS8.40).if applivab€e,and 0lSo erd0r"Conkarninr dad Soil'or"Debris'if the waste will be <br /> hnaW ugirng enc of the Oemalive tmahrnerlt teM lokgie5 QfoMed by 268-49(c)-salt.of 268.4 debris <br /> Column 5;t=ruer the letter of the apPfWr!We pangr? l from below(sw Appendix 1 for other options r;neDd4 <br /> Wumn 6;Fu FODI-f006,please wer ft Reference Numbers;lw--ged betowfor Me constab.renrs in your waste stream subject to treatment- <br /> Colum 7:For F039,D001-DW.debris&Contaminated Soil: please iist the R2fererwce Number lim, a in Appendix 2 for any Underlying Hazardous <br /> Constituents <br /> Check One <br /> R ubted urlcterty�rig Hazardous <br /> WglifeSt Line Nurr W U.S.EPA Kazar6oua s H�+r Asbg TixlS Constltaents <br /> or Man rest Une item Waste Codes �u�Cakcgary m avid Be r f2Oa uenw for D001-x043, <br /> Managed? For F001fi005 <br /> NW V4 VV Debris or Soil <br /> Column 5 Waste M artagernerrt C069S <br /> Column B F044-F045 Reference Numbers <br /> Column 7 I-DO43 Referance Numbers <br /> I hereby certify that all inform ssib5crit>ed at this ares 3I1 35SCCij*d 4CCurnenlla is Carr plate and accurate to the hest of my kno edge ar-d <br /> information. <br /> Thle; <br /> Generator Sigriahuva; (ilk <br /> PrIntad NNamg <br />