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DIK ENVIRONMENTAL LAND DISPOSAL RESTRICTION FORM G£NERATOR:�ASA E;PS6'6u EPA I.D,NUMBER:r_A(_t)():3 2 6S Zai 1 ASTE APPROVAL NUMBER:_ _ ( _ MANIFESTN/LINE ITEM:(With Shi ment +'• ASTE IS ICHECK ONE). ( J DEBRIS J J NON-WASTEWATER j J WASTEWATER EPA WASTE CODES (S) SUBCATEGORY FOR DEBRIS-CONTAMINANTS SUBJECT TO TREATMENT —.,. .�asle IS J DO01 — D043 See Attachment I. Blom NJ ;4f 'LSaTEaRn�aas I RESTRICTED WASTE SUBJECT TO TREATMENT(40 CFR 268.7(a)(1)) The restricted waste identified above must be treated to the applicable treatment standards promulgated to 40 CFR 268.40, or treated to comps. ,vuh the applicable prohibitions set forth in Pan 268.32 or RCIIA Section 300(d). I have attached all supporting analytical data, where available I ( J Waste contains underlying hazardous constituents that do not meet all treatment standards as listed to 40 CFR 268 48 and rec_ - further treatment, see Attachment I. Waste does not contain underlying hazardous constituents exceeding rreaimen(standards as listed to 40 CFR 268 48 l al underlying hazardous constituents meet treatment standards), 3. 1 ) Underlying hazardous constituents standards do not apply. 4. I J Restricted waste with technology based treatment standards(40 CFR 268.7(b)(5)(ii)) List the applicable five letter treatment codes(s): RESTRICTED WASTE MEETS TREATMENT STANDARDS(40 CFR 268.7(a)(2)) The restricted waste identified above meets the treatment standards in 40 CFR 268.40 and can be land disposed without further treatment I na%e 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 analysts and testing or through knowledge of the waste to support this certification that the waste complies with the treatment standards specified in 40 CFR Pan 268 Subpart D and all the applicable prohibitions set forth in 40 CFR 268.32 or RCRA Section 3004 (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 th, possibility of fine and imprisonment. I HAZARDOUS DEBRIS SUBJECT TO TREATMENT(40 CFR 268.7(a)(I)(Iv)) This hazardous debris must be treated to the alternative treatment standards promulgated in 40 CFR 268.45 u I I RESTRICTED WASTE DECHARACTERIZED BUT REQUIRES TREATMENT FOR UNDERLYING HAZARDOUS CONSTITUENT (40 CFR 268.7(b)(5)(1v)) Cenify under penalty of law that the waste has been treated to accordance with the requirements of 40 CFR 26840 to remo.e the b, ar.,_. :naractenstic This deeharactenzed waste contains underlying hazardous constituents that require funher treatment to mec: unlcersal ire]:ne- >:::noards I in,aware that there are stgmficant penalties for submitting a false certification,including the possibility of fine and imprior—er- �TRICTED WASTE TREATED TO TREATMENT STANDARDS(40 CFR 268.7(b)(5)(1)) reatmcni residue, or extract of such residue, of the restricted waste identified above has been tested to assure that me Rcatmem rrs,._c> r men the applicable treatment standards to 40 CFR 268.40 and/or performance standard In 40 CFR 268.45. 1 hate attached all Sc.:\ :nalvtical data where available. (eemfy under penalty of law that 1 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 those individuals responsible for obtaining this information, 1 bel sive that the operated and all a 768.Subpart D.and all applicprocess has been and maintained properly so as to comply with the performance levels specified to 40 CFR Par. was¢ I am aware that there able prohibitions set forth in 40 CFR 268.32 or RCRA Section 300(d)without impermissible dilution of the prohtbuee are significant penalties for submitting a false certification,including the possibility of fine and tmprisonrr¢nt. cci1; and warrant that the information that appears on this form and any appended documents is true and correct. I have con-cclly Indicated haw mN a :o Of managed In accordance to with 40 CFR 268. My certification is based on personal examination of the information submined, or Is based on n-.. :_:res of those Individuals responsible for obtaining the information. Oel ch- � L41nck 1A'yrev (PRINT) Title: Company: `iyl e^4Yn1!.c