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Mir ina 4: L=1 identify the following sections that apply to this waste stream by marking the appropriate box. ®. RESTRICTED WASTE THAT EXCEEDS TREATMENT STANDARDS OR PROHIBITION LEVELS [40 CFR 268.7(A)(1) AND CCR 22, SECTION 66268.7(A)(1)], TITL The restricted waste identified above must be awed to mea the applicable 40 CFR 268 Subpart D and CCR Truk 22, Article 4 treatment standards to comply with applicable prohibitions set forth in Part 268.32 and CCR Title 22, section .32 or Section 3 or corresponding treatment standard(s) or prohibition levels in this document and have attached, or previous ly submitted, all s f RCRA. I have ' th supporting data where available ❑ RESTRICTED WASTE TREATED TO STANDARDS OR PROHIBITION LEVELS 40 TITLE 22, section .7(b)(5)(A)l. [ 268.7(b)(5)(DANDCCR "I c certify under ®n aof nd that I have personally and am with the treatment technology and operation of the to Support this that, my inquiry of those individuals ' .. process 1tsa. treatment process has been o and lately responsible for this info ' a, I that the ed Properly so as to comply with the performaneo levels specified in 40 CFR Part 268, S all applicable prohibitions set forth in 40 CFR 268,32 or RCRA Section 3 D. and them are significantg d) without impermissible dilution of the prohibited I am aware thu penalties for submitting a false certification ' including the Possibility of fine and imprisonment." "I certify under penalty of law that I have personally examined and am with the treatment technology and operation of the u=tment process used to support this certification and that, based upon my inquiry of those individuals immediately responsible for obtaining this information, I believe that the treatment process has been operated and maintained properly so as to comply with the P Y performance levels specified in article 4 and article lI of chapter 18, division 4.5, Title 22, CCR, and all applicable prohibitions set forth in section 66268.32 or RCRA Section 3 prohibited I am aware that their are significant 0fals xer U.S.C., section 6924(4)) without impermissible dilution of the of fine and imprisonment." gnificant 'es for submitting a false certification, including the posabr'frty ❑ RESTRICTED WASTE THAT MEETS TMENT STANDARDS OR PROHIBITION LEVELS WITHOUT 268:7(a)(2) and CCR Title 22, section UT ,7(a)(2), [40 CFR IcpWy underpeualty of law that I personally have examined and amfamiliar with the waste through analysis and testing or through gm of the waste to rt this certification and that the complies with the eat standards set oath in 40 CFR 268.32 or RCRA 3 specified in 40 CFR Part 268 Subpart D and all applicable prohibitions 004(4)- I believe that the information I submittod is true, accurate, and complete. I am await there ate significant penalties for submitting a false certification, inelud'ing the possibility of fine and imprisonment." "I certitY under penaltyof law that I personally have examined rad am familiarwith the waste through analysis and testing or through knowledge of the waste to support this certification that the waste Complies with the treatment specified in CCR Title 22, division 4.5, chapter 18, article 4 and article I I and all applicable prolubitions set forth in CCR Title 22 section 66268.32 or RCRA 3004(d) (42 U.S.C. section 6924(d)). I that the info I sub is true, accurate, and complete. I am aware them are si r ind imprisonment." for submitting a false Certification, including theilit' y of Sae' RESTRICTED WASTE TREATED TO MEET A ST D AS A TECHNOLOGY [40 7(bxS)(n'Q tad CCR Trtk 228 ,7(b)(y�(B),•_ 'I certify under penalty of law that the has been in aeeardaneewith the requirements of 40 CFR 268.42. I am aware that there are significant aenalties for submitting a false certification, including the possibility of fine and imprisonment." I certify under penalty of law that tfie waste has been treated as ac cordancowithr the requirements of CCR Title 22, section 66268.42 and section 66268.108. ani iiware that there aro significant penalties for submitting a false certification. including the possibility of fine and imprisonment. " ICTED WASTE SUBJECT TO A VARIANCE rhis waste is subject to a national capacityea t1tatabilily variance, ora y -case extension. The date the waste is subject to prohibition is r o m b 3ENERATOR CERTIFICATION - hereby certify that all information if available, in this and all associated documents are complete accurate to the best of my knowledge and ability to All waste analysis data, if avaitabk, has boar preeriously sub or is ed. lame (pleaseTint P ) law_ Signatu 'rile /