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E <br />EPA ID NO: IC 1 AID 119 1811 16 18 18 113 14 14 I OMB#: 2050-0024 Expires 10/31/2007 <br />11. Description of Hazardous Wastes (See Instructions on page 16.) <br />A. Waste Codes for Federally Regulated Hazardous Wastes. Please list the waste codes of the Federal hazardous wastes <br />handled at your site. List them in the order they are presented in the regulations (e.g., D001, D003, F007, U112). Use an <br />additional page if more spaces are needed. <br />D001 <br />F003 <br />B. Waste Codes for State -Regulated (i.e., non -Federal) Hazardous Wastes. Please list the waste codes of the State -regulated <br />hazardous wastes handled at your site. List them in the order they are presented in the regulations. Use an additional page if <br />more spaces are needed for waste codes. <br />212 <br />12. Comments (See instructions on page 16.) <br />13. Certification. I certify under penalty of law that this document and all attachments were prepared under my direction or supervision <br />in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based <br />on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the <br />information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant <br />penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. <br />(See instructions on page 16.) <br />Signature of operator, owner, or an <br />authorized represTitative <br />Name and Official Title (type or print) <br />Tom Wilson (Director, Environ. Support Services) <br />Date Signed <br />(mmlddlyyyy) <br />6>4. 0 Ca <br />ty I <br />EPA Form 8700-13 A/B (Revised 1012005) Page 3 of 5 <br />