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:;POSAL RESTRICTION NOTIFICATION FORM FOR WASTES SUBJECT TO THE TREATMENT STANDARDS FOUND IN 40 CFR 268 GENERATOR NAME MANIFEST NUMBER JM Manufacturing Co. 010243248FLE Line TSD Waste Subcategory UHC'S NWW Special Approval# Code(s) or WW Conditions 1 ACT402501 F003 ACETONE,METHYL ETHYL NWW ACT15086 KETONE*,OXIDER,TOLUENE*, D001 Ignitable Wastes(TOC>10%) XYLENES-MIXED ISOMERS(SUM 343 OF O,M,&P)* D035 SPECIAL.CONDITIONS: A. Waste Requiring No Further Treatment B. Lab Pack Waste Qualifying for Alternative Treatment und 40 CFR 268.40 C. Hazardous Waste Debris subjectto standard treatment requirements,40 CFR 268.40 D. Hazardous Waste Debris subject to alternative standards in 40 CFR 268(list contaminants) E. Waste Qualifying for Exemption and not subject to Land Disposal Restriction(Explain) F. Characteristic waste that are subject to the treatment standards in 268.40(other than those expressed as a required method of treatment)that are reasonably expected to contain underlying hazardous constituents as defined in 268.2(i);are treated on-site to remove hazardous characteristic; and are sentoff site for treatment underlying hazardous constituents(list constituents) Q Characteristic wastes that contain underlying hazardous constituents as defined 268.2(1)thatare treated on-site to remove the hazardous characteristic and the underlying hazardous constituents to levels in 268.48 Universal Treatment Standards. H. For Chemical Manufacturers,Petroleum Refineries,Coke By-Product Facilities and RCRATSDF handling wastes subject to 40 CFR 61 subpart FF ONLY. This waste is"Controlled Benzene Waste"which is subject to the notification requirements of 40 CFR subpart FF_ I. Certification for contaminated soil indicating the presence or absence of characteristic and/or listed hazardous wastes. J. Certification for contaminated soil treated in accordance with 40 CFR 268.49 Waste analysis is attached where available;otherwise the Information contained herin is based upon mythorough knowledge of the waste(s). I hereby certify that I believe that the information I have submitted is true,accurate and complete. SIGNATURE TITLE DATE WASTE STREAMS IDENTIFIED BY SPECIAL CONDITION A I certify under penalty of law that I personally have examined and am familiar with the waste through analysis and testing orthrough knowledge of the waste to supportthis certification that the waste complies with the treatment standards specified in 40 CFR part268 subpartD and all applicable prohibitions setforth in 40 CFR 268.32 or RCRAsection 3004(d). I believe that the information I have submitted is true,accurate and complete. lam aware that there are significant penalties forsubmilting a false certification,including the possibility of fine and imprisonment. WASTE STREAMS IDENTIFIED BY SPECIAL CONDITION B certify under penalty of law that I personally have examined and am familiar with the waste and that lab pack contains onlywastes which have not been excluded under appendixtvto 40 CFR 268. lam aware that there are significant penalties for submitting a false certification,including fine and imprisonment. WASTE STREAMS IDENTiFlED BY SPECIAL CONDITION F I certify under penalty of law that the waste has been treated in accordance with the requirements of 40 CFR 286.40 to remove the hazardous characteristic. This decharacterized waste contains underlying hazardous constituents thatrequire further treatmentto meet universal treatment standards. I am aware that there are significant penalties for submitting a false certification,including the possibility of fine and imprisonment. WASTE STREAMS IDE"RED BY SPECIAL CONDITION G I certify under penalty of law that the waste has been treated in accordance with the requirements of 40 CFR 286.40 to remove the hazardous characteristic,and that the underlying hazardous constituents,as defined in 268.2 have been treated on site to the 268.48 Universal Treatment Standards. am aware that there are significant penalties for submitting a false certification,including the possibilityofftne and imprisonment. WASTE STREAMS IDENTIFIED BY SPECIAL CONDITION I certify under penalty of law that I personallyhave examined this contaminated soil and it[DOES/DOES NOT]contain listed hazardous waste and [DOES/DOES NOT]exhibit a characteristic of hazardous waste and requires treatment to meet the soil treatment standards as provided by268A9(c). WASTE STREAMS IDENTIFIED BY SPECIAL CONDITION J I certify under penalty of law that I have personally examined and am familiar with the treatm ent technology and operation of the treatment process used to support this certification and believe that it has been maintained and operated properly so as to compiywith treatment standards specified in 40 CFR 268.49 without impermissible dilution of the prohibited wastes. I am aware there are sigriificant penalties for submitting a false certification,including the oossibilityof fine and imprisonment. ** ORIGINAL SIGNATURE PAGE TO ACCOMPANY MANIFEST***