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x 05/07/2008 08:05 916373" --? VIALTONENG2NEER,LNG PAGE 04 <br /> w <br /> r <br /> OMM: 20500024 Expires 11/3012009 1 <br /> 11. DagaripGon of re"edous Wastes(Sea instruction on Page 17.), <br /> I <br /> A. Waste Godes for Fedey Regulated liaZardOus wastes. Pleaso list the waste codes of the Federal hazardoua wastes <br /> rall <br /> handledatyour site. 6istthem in the orderthe.y are presented in the regulations(e.g.,0001, D003,P001, 0112). Use an additlonal. <br /> page If more spaosa are needed. - - <br /> 001 , <br /> i <br /> i <br /> g. Wase+Cedes for 5tata�ftegulated(i,e,,non•Pederat)M27ardOn9 Wastes. P100ee Iist the wae4a codes of the State-regulated <br /> hazardous wastes handled et your Ma. List them in the order they are presented In the regulations. Use an addition Al page If <br /> more spaces are neoded for waste Cods%. - { <br /> i <br /> i <br /> b <br /> 12. Gommarts(See instructions on page 17,) <br /> Ur <br /> is, Certification, ice under penalty of law that this documaM and nil eifaohmerr(4 ware praparQd under my direction or supervision <br /> in accordance with a system designed to assure that qualifiod parsnnnal properly gather and evaluate the irrformatian submitted. Based <br /> on my inquiry of the person or persons who manage the system,or Nose parsons directly responsible for gata thenrir�the i 0 nn cant the <br /> Information submtited Is,to the best of my knowledge 2nd relief,of Flneaand irhpand rlsonmen fee knowing swans <br /> alatlonsere are signlflcant <br /> Penalties for submittIng False Information;inoluding the possipiiity, <br /> (see Instructions on page 17J <br /> _ . pato Signed <br /> g(gnature of operator, owner,or an - (mmiddlyyyy) <br /> auth d aatative Name and Ofllcial Title(type or print) <br /> 6 0 <br /> Paga 3 Of 3 <br /> EPA Form 6700.13 A/0(Revised 09/2007) <br /> } <br />