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05/03/04 MON 07:13 FAX <br />209 463 <br />6045 TEAM CALIPER <br />U004 <br />EPA ID NO: I ��a1J <br />I bI c) <br />OMB#: 2050-0028 Expires 1/31/2006 <br />I <br />PM <br />r <br />11. Description of Hazardous Wastes (See instructions on page 20.) <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 />D(o <br />bOo-7 <br />'Dao <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 />2 <br />.7� v <br />12. Comments (See instructions on page 20.) <br />13, Certification. I certify under penalty of law that this document and all attachments were prepared under my direction or <br />supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information <br />submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering <br />the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that <br />there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. <br />(See instructions on page 20.) <br />Signature of operator, owner, or an <br />authorize rep sentative <br />Name and Official Title (type or print) <br />ffi <br />Date Signed <br />1l(mm/dd/yyyy) <br />Fir- <br />C7.S D <br />_F 7 <br />EPA Form 8700-12 (Revised 112004) <br />