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c =' <Y<" '"b�` ,GEtERiATOR CLAS 51F1cATlaN <br /> >ryt= <br /> 1. S TTII$A USEPA KAZAROOUS WASTE? S YES NO <br /> THE FACILITY R$QSARSS RESL,TS FROM�rE AC%AL SPEW;CAFBON T}iE Umt,,E A.%Ai—EC M..ST BE RE PFSSENTAT'SA.4D M,:ST <br /> i> SUPPORT Tp4e CLASS FSCAT'Ck FOR SENZEN'E N:SW GENEW,O4S TOTA:9EA.ZENt mALYSIS S ALSO RiEQJ RED <br /> 1? IF THfS IS USEPA HAZARDOUS WASTE LIST ALL APPLICABLE WASTE COLE$rD F K P;S.U IN THS SPACE PROVIDED BELOW <br /> WASTE CODE 1: 4 „< ' `f .,WASTE CODE 2 WASTE CdoE S <br /> WASTE CODE 4' ` ' " WASTE CODE 5 ' WASTE CODE B- .A. <br /> WASTE CODl~ T w,w, y`i: WASTE CODE 8 WASTE c6DE 9 <br /> S THIS 1S A GENERATOR STATE KA2.ARD0U$WASTE? ( }YES { }NO <br /> S IDENTIFY ALL GENERATOR STATE WASTE CODES <br /> 4 <br /> IL. <br /> S THIS WASTE SUBJECT TO THE LAND OfSPOSAL RESTR)CTION NOT,FICATIONI I NO <br /> EA LIST REOUIRIwIV ENTS FOR PPE 70 HANDLE THE ABOVE WASTES <br /> GENERATOR CERTIFICAT16N <br /> I HEREBY CERTIFY THAT ALL INFORMATION ON THIS AND ALL Ai ACHED DOCUMENTS IS TRUE AND THAT THIS INFORMATION <br /> ACCURATELY DESCRIBES THE SUBJECT SPENT CARE ON E FURTHER CERTIFY THAT ALL SAMPLES AND ANALYSES SUBMITTED <br /> RE REPRESENTATIVE OF THE SUBJECT SPENT CARSON IN ACCORDANCE VA T H THE PROCEDURES ESTABLISH90IN 40 CFR <br /> 61 APPENDIX I OR BY USING AN EQUIVALENT METHOD ALL RELEVANT INFORMATION RF-GAR09NG KNOWN OR SUSPECTED <br /> HAZARDS IN'THE POSSE'xSS$ON OF THE GENERATOR HAS SEEK 3ISCLOSE:D 1 AUTHORIZE WCAI TO OBTAIN A SAMPLE FROM <br /> ANY WASTE SHIPMENT FOR PURPOSES Of CONFIRMATION OR FURTHER INVESTJGATION IF I AMA CONSULTANT SIGNING <br /> ON BEHALF OF THE GENERATOR I HAVE THEIR PFtC;)ER APPROVAL <br /> =PRINTED-NAME, G L. Converse <br /> SIGNATURE;- <br /> i <br /> TITLE Protect G001092-sL <br /> DATE- <br /> t+C1i PROFILSw FORM A!'b i <br /> PAGE <br />