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American Ecology Corporation Land Disposal Restrictlon Form GENERATOR.J�qc,t L4g1iflGS UA 5fteAt l L^1JY7cS 4 EPA LD. NUMBER; C4LODDJYA79 WASTE STREAM or PROFILE NUMBER:0701377 ID MANIFEST DOC. N0. ©EOgS3� LINE NO.9 16' f WASTE IS A; ❑ WASTEWATER `UOWWASTEVYATER ❑ DEBRIS NOTIFICATION FREQUENCY: ❑ ONETIME REQUIRED WITH EACH SHIPMENT EPA WASTE CODES (from 40 CFR 268.40); -DtV UNDERLYING HAZARDOUS CONSTITUENTS (from 40 CFR 268.48): A. ❑ Restricted Waste Meets Treatment Standards (40 CFR 268,7(a) (3)) The restricted waste Idenllited above meals the treatment standards In 40 CPR 268,40 or Alternative LDR treatment standards for contaminated soil 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. 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 posalblilty of a fine and Imprisonment, B, ❑ Restricted Waste Treated To Treatment Standards (4.0 CFR 288,7(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 (he treatment residues or extract meet all applicable treatment standards In 40 CFR 266.40 and/or performance standards In 40 CFR 288.45. 1 have attached all supporting analytical data, where avallabie, 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 compiles with the treatment standards specified in 40 CPR 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 and'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 certification and that based on my Inquiry of thoso Indlvlduals 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 specified In 40 CFR 268,40, 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 UHC (40 CFR 268.9) 1 certify under penalty of law that the waste has been (reeled In accordance with the requirements of 40 CFR 268.40 to remove the hazardous characteristic. This decharacierized waste contains Underlying Hazardous Constituents (UHC) that require further treatment to moat the universal treatment standards. I am aware that there are significant penalties for submitting a false certlflcallon, Including the possibility of a fine and Imprisonment. E. Restricted Waste Subject To Treatment (40 CFR 268,7(a) (2)) The reslricleci waste identified above must be treated to the applicable treatment standards In 40 CFR 268,40, or treated to comply with applicable prohibitions set forth In Part 268.32 or RCRA Section 3004(d). I have attached all supporling analytical data, where available, F. Hazardous Debris Subject To Treatment (40 CFR 268,45) This hazardous debris identified above must be treated to the aiternallve treatment standards In 40 CFR 268.45. G. ❑ Restricted Waste Subject To A Variance or Extension (40 CFR 268,7(a) (4)) This restricted waste Identified above Is sub)ecl to a case by case exempllon under 40 CFR 268.5, an exemption under 40 CFR 268.6 or a nationwide capacity variance under Subpart C of 40 CFR 268, and Is not prohibited from land disposal. LAR 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 anelyllwl data, where available, H. ❑ Restricted Waste Managed In A "Lab Pook" (40 GFR 268,7(a) (9)) I certify under penalty of law that I personally have examined and am familiar with the 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). I am aware that there aro significant penalties for submitting a false certification, including the possibility of a flne 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 submitted, or Is based on my Inquiries of those Individuals responsible for obtaining the Infori Authorized Signature Title Date ` l r UHC list from 40 CFR Part 268,48 availtable upon request G L IVEIrL SEP 08 2015