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Section IV (Cont.) Check mark the underlying hazardous constituents likely to be present. <br /> _Pentachlorodibenzo-furans __ Tetrachlorodibenzofurans Vemolate <br /> Pentachloroethane _1,1,1,2-Tetrachloroethane _Vinyl chloride <br /> Pentachloronitrobenzene _1,1,2,2-Tetrachloroethane _Xylenes(total) <br /> _Pentachlorophenol Tetrachloroethylene Antimony <br /> Phenacetin __2,3,4,6-Tetrachlorophenol Arsenic <br /> —Phenanthrene Thiodicarb _Barium <br /> Phenol Thiophanate-methyl Beryllium <br /> o-Phenylenediamine _Tirpate _Cadmium <br /> _Phorate _Toluene _Chromium(total) <br /> Phthalic acid _Toxaphene _Cyanide(total) <br /> _Phthalic anhydride Triallate _Cyanide(amenable) <br /> _Physostigmine __ Tdbromomethane(Bromoform) ®Fluoride <br /> _Physostigmine salicylate _2,4,6-Tribromophenol _Lead <br /> _Promecarb _1,2,4-Trichlorobenzene Mercury(retort residues) <br /> Pronamide _1,1,1-Trichloroethane _Mercury(all others) <br /> Propanenitrile(Ethyl cyanide) —1,1,2-Trichloroethane _Nickel <br /> Propham Trichloroethylene _Selenium <br /> _Propoxur Trichloromonofluoromethane _Silver <br /> _Prosulfocarb 2,4,5-Trichlorophenol _Sulfide <br /> _Pyrene __2,4,6-Trichlorophenol _Thallium <br /> _,Pyridine ®2,4,5-Trichlorophenoxyacetic acid Vanadium <br /> _Safrole (2,4,5-T) Zinc <br /> _Silvex(2,4,5-TP) _1,2,3-Trichloropropane <br /> _1,2,4,5-Tetrachlorobenzene ®1,1,2-Tdchloro-1,2,2-trifluoroethane <br /> _Tetrachlorodi-benzo-p-dioxins dethylamine <br /> tris(2,3-dibromopropyl)phosphate <br /> Section V Certification for wastes that meet the treatment standard as required by 40 GFR 268.7(a) (3). <br /> Note. Complete and sign this section 20.Ly if your are certifying that the waste meets the treatment standards specified in 40 CFR <br /> 268,Subpart D at the original point of generation. <br /> I certify under penalty of law that I personally have examined and am familiar with the waste through analysis and testing or through <br /> knowledge of the waste to support this certification that the waste complies with the treatment standards specified in 40 CFR part 268 <br /> Subpart D. 1 believe that the information I submitted is true,accurate,and complete. I am aware that there are significant penalties <br /> for submitting a false certification,including the possibility of a fine and imprisonment. <br /> Authorized Signature <br /> Print Name %% eel <br /> Title <br /> Company wtev-lake- <br /> Date <br /> Systech has prepared this form for the convenience of its customers to comply with the notification requirements under the Land Disposal <br /> Restrictions(LDR)Program in 40 CFR Part 268. Systech believes that it addresses all of the notification requirements imposed by the <br /> LDR regulations as they apply to our customers. The regulations impose on the generator the responsibility for proper LDR notification. <br /> Therefore,the generator should ensure that he has complied with all of the LDR notification requirements when using this form. <br /> NOTIFICATION REVISION OCT.98(TSV1i) <br />