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Stericycle E'nviroltttasrrtal Solutions <br /> "CRA Land Disposal Restrictfott Not, <br /> t✓'arttt <br /> Generator: Work Order R <br /> F US EPA ID� <br /> PSC Profile O <br /> No. <br /> -!'Manifest <br /> 140. <br /> Irt actor d nce and lyh7 40 CFR 268.7(a), iMac ruaderlying ha�ar dotrs canstitrrents utarst be add" <br /> taj2dai}, "trnelerlyirtg ha-ar darts constituent"means any cafe' oz trt listed in <br /> Star?dart- tishiclt c essed in this tivaste. Per <br /> ora reasonably 6e expected to be r• 6g�$ Table LITS <br /> eoneerrtr•atron above the constituent-s eci rc p esent at the point o e --Universal Treafitent <br /> code(s), tr eatabili p f LITS n"eatnrent startdai'd l o e1 generation of the hazardous Ivaste, at a <br /> ty gr oup, <br /> and srr6categor�,applicable to this waste. f '�Qrl73'EZ (attached <br /> for the waste <br /> Irt order to addr-ess rrnder•lying hazardous constituents In characteristic wastes,please check the appr•opr•iate bot: <br /> underlying hazardous constituents reasonably expected to be present in th sdw waste there are no <br /> I have reviewed the UTS list of 268.4$, and et. aste, <br /> hazardous constituents are present in this waste. The determined that underlyi�ig <br /> identified as follows: Yg hazardous constituents are <br /> ?'lie determination ofrrrtder•1}�irtg haaar•do:rs corrstittrents was based ora: <br /> Ci Generator's knowledge of the waste <br /> Analysis <br /> I certifv that I personally have examined and am faniiIiar%vith the tvaste through analysis and <br /> kziowledge ofthe tivaste to support this cerci icatian.I certify that as an authorizedn re <br /> named above, all the information submitted in this notification is true and correct to the testing, or throzl <br /> repre a of the generator <br /> best of my,knowledge. <br /> Printed Name <br /> Signature <br /> Date <br /> Form EZ Revised o7/31/9S <br /> This is a t;vo sided form <br />