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American Eco[ogLj Corporat'orfr _a -d D�.sposal, Restrialicn. r=oan q GENERATOR:�Me. LO1,14(G D4,4 7rGCI r L� G1 r.!�'.NJEc� Ca'`�C L`tL'" 33i{r7 I WASTE STREAM or PROFILE NUMS=?: 01b1m to-" tX> OVRL: LIMB N_ . t WASTE IS A: ❑ WASTENATER NOTIFICATION FREQUENCY: EPA WASTE CODES (Prom 4a CFR 256 UNDERLYING HAZARDOUS CONSTITUE!rB 2:? A. ❑ Restricted Waste f. ears T r -_=--a _ : -= -: -: Z2: - a' T. -e rest lrted''raa:9 idgr' ter, -.:c,= -.Ti standards for ccntar• -atec' s•: 3upcdrlirg arta;'!`. ":a' _ n"?? s I certify under peva ar, x ::-e a at=- __-: a- `a- _ „ . r •,rite :ere;,^ a and testing or tnr:_,- 3 :_ -a: _- r: _ _ :� - s treatment. standar!:= s _ : - c: =a- .:: _ _::-- _ _ _ - - _• : accurate and com: _:ea a«a•:._,.._,-, ; including the oo3s z :. _ B. ❑ Restricted Waste T e,te, '•Ga: -e,-. The treatm=.t rent _. : _ .' _ _ :- _: c-- _ =`--?: n B> _ :. - -. = a:: 2 -as .. ?- :- treatment res!.'ues c- 268,45. :: a:a law o; 1" ; 268.45. 1 have I certify ands.' p2 : .-c'=_•S:'_ c eYe— -5: _-: _— IS- A , ilia %%$Ste thrc uph and testing or throe; �^w.:v-- -? na5.5 .= ;_-?'. -s; r- treatmentstandards s= :_ a-:2:: accurate and comolet= Including the poss:b C. ❑ Restricted Waste'. I certify under pera tree:-=-: _ - -3== = ' == =' _ _ _ - '-- r•» Inquiry Of thane operation of the individuals Immediate ; =s.- _ : _ - °• • !' 4 :raatmenl prcrss has been operated arts ma r.e - _ _ :::e s- a:._ ::-_ . „ . _ -ds Seecif ed In ah c.FF : is ail, without lmpermiSSlt,S ' -- = - •-- _ _- - _ A -c g^ ?nal?' ? A'? c _ ! :dill Par811'i F li' submitting a false ce : _ -_ -= D. ❑ Restricted Waste I certify unde-pera!/ •-- _ ant: � - - -. _2'!e .� ",� ` ^d; its:. , i' the hazardous charade' 5' : 7--. _ _ s ,,ec lcl sl;r u!., . further treatment to nree• certification, InCIUoin'Jt-5::__:E. Restricted Waste S',b:sct To 7-ea—el- -e?ye= „=R _:5.7 a' lC The rest.IC9- .? `?- :3-.'S i" �-•� :h: +� ci lleatR�1 ;C comply with applicable p' = = • -_ - - - date, where eyailaole F. ❑ Hazardous Debris Subject T Tra2:^ e _ Z_=R -=S = This hazardous deo"3 'e= G. ❑ Restricted v%laste Subject TC This rastricteb w as:e :3e-: ,ec 3:-.e ~ s -• _ _ _ _ _ , < - , z; ; c 268.8 or a nalicn Nde :a _ - _ S •sS _ ,3 - e5:. •4'-'e^; S?H 9" 5` d't prohibitio-,s becor•e of s-, .e :- ax _ - , a: e` promulgated .n 40 CFR 2 a.4� i ra'.e 3"a:'?: 3 s__x- H. [] Restricted Waste fti"anaged In A "-e. a-_ k; Q(4 eTi R�"$ Sa nd a� `a^i`i'iit, .%Ith tna waste and that Ulo lets I certify under penalty of law that : pe_s : -3 have bee- ax: _:e:_ -=er aope^d's'', to -AC CFR Fan 2f and that thl5 Inh pnc . In pack contains only ,Naito that be sent to a combustion fact' :; "tT': a"-? e a 1.3-?;�, a ?'eat- a 1; stnndn•ds for lot? vocks et -0l0 C .-R 268.42(c). I am aware that there a- =a -• - : es rc s_,- a fa se :er,'� cation, Inclu;il itr tl a possibility of a fire and Impnsor-e_. I certify and warrant that the information that appears or ;�'s fc?� and appended doctrrnents, is t' 010 ('111d'" I have correctly Indicated how my Waste is to be manages .n ac=ctdance with 40,CFR 2i� 8 A1) certificntiotl IT, based on personal examination of the Informations bmitted, or Is based on my Inquiries of thoso Indlt�iduulb responsible for obtaining the Inform )op. Authorized Signature r 7/ %�✓3' / Title EIVE I lue, lint frnm a0 CFR Part268.48 available a of re u SEP 0 8 niq Scanned by CamScanner ENVIRONMENTAL