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The waste(s) identified on the above referenced manifest and bearing the California waste number(s) identified below is subject to the, Land Disposal Restrictions of CM Title
<br />22, Division 4.5, Chapter I&
<br />PART H: Waste Identification.. l g I
<br />California waste number(s)
<br />Check the appropriate boxes. (Mom than one box may apply.)
<br />PART UL Handling Method .
<br />Check the appropriate lines. (Mom than one fine may apply.)
<br />-1. The waste is regulated under RCRA and must be handled in accordance with the attached UA LAND DISMAL REM=N N-OTTFICA770N.
<br />The waste identified above must be treated to meet the applicable standards in CCR, Tide 22, Division 4.5, Chapter 19, Article 11.
<br />_3. The waste identified above can be land disposed without further treatment.
<br />"I certify under penalty of law that I personally have examined and am familiar with the waste through analysis and testing or through knowledge of the
<br />waste to support this certification, that the waste complies with the treatment standards specified in CCR Title 22, division 4.5, chapter 18, article 4 and
<br />arcle 11 and all applicable prohibitions set forth in CCR Tide 22, section 66268.32 or RCRA section 30D4(d) (42 U.S.C. section 6924(d)). I believe that the
<br />info mation I submitted is hue, accurate, and complete. I am aware that there are significant penalties for submitting a false certification, including the poss
<br />bility of a fine and imprisonment."
<br />_4. The asbestos waste identified above can be land disposed without fusilia treatment.
<br />"I warrant that I am an authorized representative of the generator. I certify under penalty of law that the waste complies with the treatment standards
<br />specified in CCR Tide 22, division 4.5, chapter 18, section 66268.114.1 believe that the infonnation I submitted is am accurate, and complete. I am aware
<br />that there are significant penalties for submitting afalse certification, including the possibility of a fine and item t"
<br />4J- The waste identified above is subject to a variance. The effective date of the prohibition is(input the actual effective
<br />prohibition date from Part U above)....
<br />PART IV- Generator Certification.
<br />I warrant that I am an authorized representative of the generator. I.ccrtifrr. under. penalty of law. that thewastecomplies with, the treatment.standards specified,in -CCR. Mde,22.-I--
<br />7no
<br />4.5, Chapter 18, Swdon(s) 66268. 1 believe that the information I submitted is true, accurate, and complete. I am aware that there am significant penalties for submitting
<br />certification. including the possibility of a fine and imprisonment. -si,
<br />-*ignature:
<br />,o Date:
<br />Print or Type Name:
<br />Tide:
<br />0 3 Rev 11/94
<br />1"
<br />State of California
<br />Restricted Now-RCRA Waste Description Listed in 22 CCR 662"
<br />fthibition
<br />Effective
<br />Date
<br />Corresponding
<br />Treatment Standard
<br />(from 22CCR)
<br />1.
<br />aqueous waste identified in section 66268.29(a)
<br />in effect
<br />6626&107(a).
<br />z
<br />PCB wastes kkadfied in section 66268.29(6) .
<br />in effect -
<br />66268.110
<br />I
<br />Awn, shredder waste' in section 66268I9(c)
<br />in effect
<br />66268.106(aXI)
<br />4.
<br />'Nonwanewater solvent waste k1catified in ration 6626&29(4)
<br />in effect
<br />6626&107(b)
<br />5.
<br />Hazardous waste foundry sand identified in section 66268.29(e)
<br />in effect
<br />66268.106(a)(2)
<br />6.
<br />Mctat-contzimimg solid waste identified in section 66268.290
<br />111/95
<br />66268.106(aX3)
<br />7.
<br />Fly ash, boutim ask retort or bagbouse waste identified in section 6626&29(h)
<br />in effect
<br />66268.106(aX4).
<br />aX4)
<br />&
<br />Bagbouse wast from foundries identified in section 66268—xXi)
<br />in effect
<br />66268.106(aXS)
<br />9.
<br />Aqw= and liquid organic waste identified in section 6626919(j)
<br />111195
<br />66268.112
<br />I im
<br />sow waste containing organics identified in section 6626&29(k)
<br />1AM
<br />66268.113
<br />Asbestos-cootaining waste' in section 6626819(m).
<br />in effect
<br />6626&�NI14
<br />Ill...
<br />12
<br />tent standard. Sea section 66268.1(h)
<br />in effiCa
<br />HSC 251 Xl)
<br />PART UL Handling Method .
<br />Check the appropriate lines. (Mom than one fine may apply.)
<br />-1. The waste is regulated under RCRA and must be handled in accordance with the attached UA LAND DISMAL REM=N N-OTTFICA770N.
<br />The waste identified above must be treated to meet the applicable standards in CCR, Tide 22, Division 4.5, Chapter 19, Article 11.
<br />_3. The waste identified above can be land disposed without further treatment.
<br />"I certify under penalty of law that I personally have examined and am familiar with the waste through analysis and testing or through knowledge of the
<br />waste to support this certification, that the waste complies with the treatment standards specified in CCR Title 22, division 4.5, chapter 18, article 4 and
<br />arcle 11 and all applicable prohibitions set forth in CCR Tide 22, section 66268.32 or RCRA section 30D4(d) (42 U.S.C. section 6924(d)). I believe that the
<br />info mation I submitted is hue, accurate, and complete. I am aware that there are significant penalties for submitting a false certification, including the poss
<br />bility of a fine and imprisonment."
<br />_4. The asbestos waste identified above can be land disposed without fusilia treatment.
<br />"I warrant that I am an authorized representative of the generator. I certify under penalty of law that the waste complies with the treatment standards
<br />specified in CCR Tide 22, division 4.5, chapter 18, section 66268.114.1 believe that the infonnation I submitted is am accurate, and complete. I am aware
<br />that there are significant penalties for submitting afalse certification, including the possibility of a fine and item t"
<br />4J- The waste identified above is subject to a variance. The effective date of the prohibition is(input the actual effective
<br />prohibition date from Part U above)....
<br />PART IV- Generator Certification.
<br />I warrant that I am an authorized representative of the generator. I.ccrtifrr. under. penalty of law. that thewastecomplies with, the treatment.standards specified,in -CCR. Mde,22.-I--
<br />7no
<br />4.5, Chapter 18, Swdon(s) 66268. 1 believe that the information I submitted is true, accurate, and complete. I am aware that there am significant penalties for submitting
<br />certification. including the possibility of a fine and imprisonment. -si,
<br />-*ignature:
<br />,o Date:
<br />Print or Type Name:
<br />Tide:
<br />0 3 Rev 11/94
<br />1"
<br />
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