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American Ecology Corporatlon Land Disposal Restriction Form GENERATOR: :M9Ld %DL `S"T< ��2& AZ EPA I,D, NUMBER: WASTE STREAM or PROFILE NUMBERt�°T] (�)� iICJ —AZ MANIFEST DOC, NO,C f Ci)16l&NO. _] WASTE 15 A; ❑ WASTEWATER ❑ NON -WASTEWATER 9 DEBRIS NOTIFICATION FREQUENCY: ONE TIME r•I� REQUIRED WITH EACH SHIPMENT .4 EPA WASTE CODES (from 40 CFR 26SO: ��. UNDERLYING HAZARDOUS CONSTITUENTS (from 40 CFR 268.48): A. ❑ Restricted Waste Meets Treatment Standards (40 CFR 268,7(a) (3)) The restricted waste Idenllfled above meets the treatment standards in 40 CFR 208.40 or Alternative LDR treatment standards for contaminated soll 400FR268.49 and can be landfill disposed without further treatment. I have attached all supporting analytical data, where available. 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 waste to support this certification that the waste complies with the treatment standards specified In 40 CFR Part 268 Subpart D. 1 believe that the Information I submitted Is true, accurate and complete. I am aware that there are significant penalties for submitting a false certification, Including the possibility of a fine and Imprisonment, B, ❑ Restricted Waste Treated To Treatment Standards (40 CFR 206.7(b) (1) & 268,7 (b) (2)) The treatment residue, or extract of such residue, or the restricted waste identified above has been tested to assure that the treatment residues or extract meet all applicable treatment standards In 40 CFR 268.40 and/or performance standards In 40 CFR 268,45. 1 have attached all supporting analytical data, where ava;lable. I certify tinder penalty of law that I personally have examined and am familiar with the waste through analysts and testing or through knowh)dge of the waste to support this certification that the waste complies with the treatment standards specified in•40 CFR Part 268 Subpart D. I believe that the Information i submitted is true, accurate and complete. I am aware that there are significant penalties for submitting a false certification, Including the possibility of a fine a6d'Imprisonment. C, ❑ Restricted Waste With Technology Based Treatment Standards (40 CFR 268,7(b) (4)) 1 certify under penalty of law that I personally have examined and am familiar with the treatment technology and operation of the treatment process used to support this cortificatlon and that based on 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 treatment standards specifled in 40 CFR 208,40, without Impermissible dilution of the prohibited waste, I am aware that there are significant penalties for submitting a false certification, Including the possibility of a fine and Imprisonment. D. ❑ Restricted Waste Decharacterized But Requires Treatment For UNC (40 CFR 268.9) 1 certify under penally of law that the waste has been treated In accordance with the requirements of 40 CFR 268.40 to remtwe the harardous characteristic. This decharacterized waste contains Underlying Hazardous Constituents (UHC) that requifo further treatment to meet the universal trealment standards. I am aware that there are significant penalties for sul)mllting a foisr- codillcellon, including the possibility of a fine and imprisonment. E, ❑ Restricted Waste Subject To Treatment (40 CFR 268.7(a) (2)) The restricted waste Identified above must be treated to the applicable treatment standards In 40 CFR 208,40, or treated to comply with applicable prohibitions set forth In Pari 268.32 or RCRA Section 3004(d). I have attached all supporting analytical data, where available, F. ❑ Hazardous Debris Subject To Treatment (40 CFR 268,46) This hazardous debris Identified above must be treated to Ilse alternative treatment standards in 40 GFR 268.45. o. ❑ Restricted Waste Subject To A Variance or Extension (40 CFR 268,7(a) (4)) This restricted waste Identified above is subject to a case by case exemption tinder 40 CFR 268.5, an exemption under 40 CFR 268,6 or a nationwide capacity variance tinder Subpart C of 40 CFR 268, and Is not prohibited from lend disposal. LOR prohibitions become effective on (date) for this restricted waste. The corresponding treatment slandard(s) are promulgated In 40 CFR 268.40, 1 have attached all supporting analytical data, where available. H. ❑ Rdstrlcted Waste Managed In A "Lab Pack" (40 CFR 268.7(a) (9)) 1 certify under penalty of law that I personally have examined and am famliler wlth tho waste and that the lab pack contains only waste that have been excluded under appendix IV to 40 CFR Part 268 and that this lab pack may be sent to a combustion facility In compliance with the alternative treatment standards for lab packs at 40 CFR 268,42(c). 1 am aware that there are significant penalties for submitting a false certification, Including the possibility of a fine and Imprisonment. I certify and warrant that the Information that appears on this form, and appended documents, Is true and correct I have correctly Indicated how my waste is to be managed In accordance with 40 CFR 268, My certification is based on personal examination of the information su rnitted, or Is based on my inquiries of those individuals responsible for obtaining the inf ri Authorized 91griature Title UHC list from 40 CFR Part 268,48 avallable upon reques�� to SEP 08 2015 t=NVIBOUFNTAI