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US ECOLOGY, . LAND DISPOSAL REOFFLICTION FORM GENERATOR: INTERLAKE MATERIAL HANDLING INC EPA I.D.NUMBER: CAD074642901 WASTE STREAM NUMBER 07-012-8219-3 ]MANIFEST#:(With Shipment) 22068714 WASTE IS(CHECK ONE): [ ]DEBRIS kj NON-WASTEWATER [ ]WASTEWATER EPA WASTE CODES(S) SUBCATEGORY FOR DEBRIS-CONTAMINANTS SUBJECT TO TREATMENT Check if waste is the following: ❑ F001-17005-See Attachment l (Top Section) ❑ D001-13043- See Attachment 2 ❑ F039-See Attachment 2 ❑ Calif List Restricted - See Attachment 1 (Bottom Section) If treatment standards are expressed as a specified technology then list the applicable five(5)letter treatment code(s): A. 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 have 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 analysis and testing or through knowledge of the waste to support this certification that the waste complies with the treatment standards specified in 40 CFR Part 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 the possibility of fine and imprisonment. B. [ ] RESTRICTED WASTE TREATED TO TREATMENT STANDARDS(40 CFR 268.7(b)(5)(i)) The treatment residue,or extract of such residue,of the restricted waste identified above has been tested to assure that the treatment residues or extract meet the applicable treatment standards in 40 CFR 268.40 and/or performance standard in 40 CFR 268.45.I have attached all supporting analytical data where available. I certify under penalty of law that I 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,I believe that the treatment process has been operated and maintained properly so as to comply with the performance levels specified in 40 CFR Part 268,Subpart D, and all applicable prohibitions set forth in 40 CFR 268.32 or RCRA Section 300(d)without impermissible dilution of the prohibited waste.I am aware that there are significant penalties for submitting a false certification,including the possibility of fine and imprisonment. C. [ ] RESTRICTED WASTE WITH TECHNOLOGY BASED TREATMENT STANDARDS(40 CFR 268.7(b)(5)(ii)) I certify undre penalty of law that the waste has been treated in accordance with the requirements of 40 CFR 268.40.I am aware that there are significant penalties for submitting a false certification,including the possibility of fine and imprisonment. D. [ ] RESTRICTED WASTE DECHARACTERIZED BUT REQUIRES TREATMENT FOR UNDERLYING HAZARDOUS CONSTITUENTS(40 CFR 268.7(b)(5)(iv)) I certify under penalty of law that the waste has been treated in accordance with the requirements of 40 CFR 268.40 to remove the hazardous characteristic.This decharacterized waste contains underlying hazardous constituents that require further treatment to meet universal treatment standards. I am aware that there are significant penalties for submitting a false certification,including the possibility of fine and imprisonment. E. [ ] RESTRICTED WASTE SUBJECT TO TREATMENT(40 CFR 268.7(a)(1)) The restricted waste identified above must be reated to the applicable treatment standards promulgated in 40 CFR 268.40,or treated to comply with the applicable prohibitions set forth in Part 268.32 or RCRA Section 3004(d).I have attached all supporting analytical data,where available. E] Waste contains underlying hazardous constituents that meet all treatment standards as listed in 40 CFR 268.68,see Attachment 2. ❑ Waste contains underlying hazardous constituents that do not meet all treatment standards as listed in 40 CFR 268.68 and require further treatment,see Attachment 2. ❑ Waste does not contain any underlying hazardous constituents as listed in 40 CFR 268.68 ❑ Underlying hazardous constituents standards do not apply. F. [ ] HAZARDOUS DEBRIS SUBJECT TO TREATMENT(40 CFR 268.7(a)(1)(iv)) This hazardous debris must be treated to the alternative treatment standards promulgated in 40 CFR 268.45. I certify and warrant that the information that appears on this form and any appended documents is true and correct.I have correctly indicated how my waste is to be managed in accordance with 40 CFR 268.My certification is based on personal examination of the information submitted,or is based on my inquires of those individuals responsible for obtaining the information. Name: Title: Date: Signature: Company: I,