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01 <br /> Was the wastewater tested for anything other than the above contam, ants? Yes No� <br /> If "Yes". please describe tests and attach copies of the test results. <br /> Is there any other analytical test data (eq soil samples) for this site? YesE No� <br /> Is there any soil vapor monitoring data for this site? Yeso No� <br /> Please describe the appearance of the waste water? <br /> Color <br /> Estimated amount of sediment (%wt) <br /> Is there evidence of an emulsion? Yeso No� <br /> Estmated Volume of wastewater(USG) <br /> Generators Certification that Wastewater is Non-Hazardous. <br /> DESCRIPTION OF WATER., D"i PAZ. ua/�67€ <br /> NON-HAZARDOUS WASTE WATER,MONITORING WELL PURGE WATER AND/OR AUGER RINSATE,TANK RIN_S_A_T_E <br /> AND AS DESCRIBED ABOVE THIS WATER MAY CONTAIN DISSOLVED HYDROCARBONS. <br /> I CERTIFY THAT THE ABOVE NAMED MATERIAL IS A LIQUID EXEMPT FROM RCRA PER 40 CFR 261.4 (b)(1 O)AND <br /> DOES NOT MEET THE CRITERIA OF HAZARDOUS WASTE AS DESCRIBED IN 22 CCR ARTICLE 1 1 OR ANY OTHER <br /> APPLICABLE STATE LAW, HAS SLEN PROPERLY DESCRIBED,CLASSIFIED AND PACKAGED AND IS IN PROPER <br /> CONDITION FOR TRANSPORTATION ACCORDING TO APPLICABLE REGULATIONS. <br /> The information and representations presented above are true and correct to the best of my knowledge. <br /> L <br /> Ap -IC <br /> Generator/Authorised A •nt Signature & Date <br /> A proval # <br /> Page 2 <br /> . .r <br />