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f <br /> InEarth <br /> Land Disposal Restriction Notification <br /> Generator Namw O'Reilry Auid parts#2765 EPA Number. GALG33k',92595 <br /> Generator Address 431)SOLITH CHEROKEE LAT LODI CA <br /> VaniteirtTrackirig Number, 2{}D22454-&CLE <br /> Instructions <br /> Colu17H7 1: List the Manifeai Line number or Manifest Line item. <br /> Column 2: Identify all U-S.EPA ti a ardaus Waste Codes that apply to this shipment. <br /> Column 3:Choose the appropriate kestability group:Non-Wastewater(NWW)or bVastemater <br /> Col u mn 4: Enter the appropriate$u bcategwy(per 40 CFR 263.40).if applicable, and a;so enter'Coniarainated Sail"or'Debris'if the wasfe wil I be <br /> treated using one of the alternative treatmenttechnologies provided by 268.49 Jc)-soil,ar 266.45-debris. <br /> Column 5:(Enter the letter of the appropriate paragraph from befaw(see Appondut 1 for olhar options it ne6ded) <br /> Cotumn e:For•F001-FORS,please enter the Reference Numbw(s)kcated below for the oanstluents in your waste slraam subject to tmamenl <br /> Column 7,Fpr FO39,D001-DG43, t7ebris&Ccniaminated Sail:please list the Reference Numbers listed in Appendix 2 for any Undertyirg Hazardous <br /> Gonslirttrertlg- <br /> Check Orre I <br /> Horn Must This Regulated Underb ing Hazardous . <br /> Manifest Fine Number U-S.SPA Haiardpus Carrstituents <br /> or Manifest Line Item Waste Codes ; ub-Category Waste Be Canstltuerds for D0014DO43, <br /> f W W 4VY1i Managed? For F-001-FOOS Debris of Soil <br /> 1-100663 D001 rYes _ High TOC IgnitBDle A <br /> # tAuid <br /> ' <br /> 2-100670 D001 Yes i High TOC ignitahte' A <br /> Liquid <br /> Column 5 Waste Mar13igement Codes <br /> A THIS RESTRICTED WASTE REQUIRES TREATMENT TO THE APPLICABLE STANDARD.This waste must be treater.to <br /> the applicable performance Lased L-eahnent standard set torih fn4DCFR Part 268 Subpart C,258-32,Subpart D,268-40 or <br /> RORA Section 3004(d)prior to land disposal- <br /> Co l um n 6 F001405 Reference Nu mbers <br /> Column 7 D001-D443 Reference Plumbers <br /> I hereby certify that ali information subscribed at this.ant!all associated documents is complete and awu rate to the best of my knowledge and j <br /> infaemation. <br /> Garlorator Signature: Ttr* l <br /> Printed Name: ]vF—f I- <br /> tl C t7ate <br /> t <br /> fir <br />