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VE:OLINA, LAND DISPOSAL NOTIFICATION AND CERTIFICATION FORM PHASE IV
<br /> CWIRONIACNTAL SERVrCEs
<br /> Page of____
<br /> Generator Name: �_';� rr� 9. ^ r/i EPA ID # cLit;V,'JE ''�t1 5.> '4vlan(fest Tracking Nm. 4� .�.o4
<br /> I . It waste Is a wastewater (see 40 CFR 268,2) place 'W' noxi to the applicable codes)
<br /> Profile #
<br /> 2. CODES WITH SUBCATEGORIES (place appropriate faffer (rom secllon 8 before each code that appites) (See 40 CFR 268 (or delalls) r
<br /> DWI HIM= ____ 0008 toadaddbattedos — 1(069 Hot Calcium Sallow _ pp65LoAh1EflCRos,
<br /> DWI ExceptH!•T00 � D009OrganicN0 > 260ppm � K07tRmoraRes. _ UI51HIHg
<br /> 0003 10 adtvo CyaSuIr c — DD09 (nary, yy > p� — K07i Not Rmatc Res. PpsSFit Ina/flMERC flclhaIRMERG Ras.
<br /> 11240 2. 4 ®lereb S tc
<br /> 000) Aoactivo 5uifxta 0009 Hg a 260 — KI06 Lo Amore Res,
<br /> -- DMExprosivo _ F025 Light onds ,___ KI06Not Regan; Ras, — Po92toIncRos.
<br /> DM3Wa(orReaclivas F025 ® P092LoRAfERCRos,
<br /> DWJ Unexp Ord. EMU _ Koo6 allod r — Klpb> 260 ppm Hg — PM Not Incm&fcRC Res.
<br /> U00.? OUrarRoactves K006Anhydrous — PP17Safts P092F111ndrRMERCRose
<br /> 00050attortes _ K069Cakin 5uHatn ®-- P047Nonsa((s _ UISILORMERCRer,
<br /> ose
<br /> UISILOMIRMEROficst
<br /> The subcategory (Cir 0018•D043 waste Is Veated In nonCWA(nonSDWA factlP06SUnfto e sRthe following box Is checked: 0 "freated In CWAISOWA Iacrhfihf'
<br /> 3, COMMON CODES (Placa appropriate feher (rom seciron a before each code that applies)
<br /> __._. P002 _ P012 PM ._-_POS) P49Q Pi05 �.P205 FQQ6 .� ,•f007 vFODa -,_FM9 Foto Foil F012 �Pol9 ,_ .r�06g
<br /> '—" � "— ' � � -- 7 ____� MDM 0010 wit ____0012 � _ 0013 _ 0014 _ 0015 _ 00 6 ^OOI7 _0016 0019
<br /> ..._pD20 0021 _ �2 D023 VOg24 _0025 ____ 0026 0027 MM vD029 WD030 ^ 00.71 �f7W2 ` 0033 �D011 _ 0035
<br /> _ U007 0097 _ 0 0439 _ _D040 —1X!41 a 0012 0013 �F00I " FIXYL _F003 _ _ FON � F005 �IfLb2 , ^U00.1 i,"
<br /> _ 11007 __, 11049 ®�U061 ____ 11072 11000 • Uloa _,_ 11117 _ Ul22 — 0123 _ 11136 — 11154 � UIBO a !1213 ^t/22Q _ (f27a ^112)9
<br /> ApOiTTONAL COPES (Enlorallcodas not Iden00ed above which are associated With waste) _ KOfi►
<br /> 4. USEPAHAZARDOUS WASTE 51 TREATMENT STAANOARDSFORNON•PHASEitSTATES ((N0ICATETHEAPPUCABLE 6. NOW MUST THE WASTE BE
<br /> COOE(S) TREATMENT STANOARO 260,4 t, 260,43 OR SPECIFIED TECHNOLOGY BELOW) MANAGE®? ENTER THE LETTER
<br /> FROM BELOW
<br /> aklantifyFOJ9, orUHCsrnanaped6rnonCWA, useUro F039/tinder!yingHnta MousCorulOuantsFom' provided Ord chock here* O
<br /> no UFICs aro present upon 0 onaroilon choct hero: 0 Chock hero Adtsposat fac0tty aa7f rfieck toraq UHCs 4 (lova no UNC farm "trod)
<br /> rgstaddlUonatEPAvrastoeodo(s), utathosuppfomentalshaotandrhoc$'para 0lnpauofsupplomaflat shoot youmay via mviotocopies afthtsroam
<br /> SOLVENT' CONSfl7UENTS (F001 • F005) Chacic baro U drapasot fadpfy tvr7t tfiock Pornit spoof salvanra ,•,�
<br /> aAaOtana ____, Bartzona ,.�. n;a efcahol
<br /> _ CarbonTetmdilodd0 •-._ Chbrobonzona � � Cor6ondisGgda
<br /> Cyclohoxanono — O Cr°s°I Cresols (mdp)
<br /> _ E1hyPbanzono � aOtchtorobonzona _ 2-Ethoxy0thatol ,_, Edrytawtata
<br /> _ M1folhylnno Potlda — EUr}4atthy _ fsobutarwl ` Mothanof
<br /> Maihyla1leytkoton0 lite tsobu korona
<br /> opropano ®_ Pyrid(rn KrY� � ...._. Nibobanzona
<br /> TA chforoaUtarw t, 1, 2 TdddarooUaa t ^ Talrochtorooihylarw ^ T'o(eano
<br /> Trichloromonoiiuorcrnep € no 1, to2•Tdchforo, t, 2, 24d0uomathana • Tdchtoroalh}fono
<br /> Xylanos
<br /> (Statas suthadzad by EPA to managa Iho LOR program mayhava rogWa(oryaiaterss ddloront )ram the 40 CFR diaUonsSstad below. Whore those too At4tarychaGans ddfe, pw
<br /> cowlicaUon WN bo doomed la rolorlo those slate Citations Instod of (he 40 CFA diatoms.)
<br /> d" RESTRICTEOWASTEAEOUtilESTAEATMENT
<br /> Tidr wosfo must be traatedio the applicabre treafmonl standards sot forth fn 40 CFA Ped 266.40.
<br /> ® Forltatardous Oobds: Wr hazardous dobds fs subjoci to the aitama &0 treatment standards of 40 CFR 266645.'
<br /> RESTR(CTED WASTETREATMENT TO PERFOfiMANCE STANDARDS
<br /> I OarUfy ikidar panaitjr allow that I have persona Uy exanthad and ara famlitar W lh the uoatmonP foctrnology ardopamUon of the treatment process used to supped Phis caNE<afOm Oased
<br /> awith the nmydngdryoflhos0 &xlJvtduafs &nma aPotyro ponstbfa /0rablarornathiskrformatlan• ibopavo #letthetraatmont process has been oporatedand matntaModproperlytoubco
<br /> canittcaffon, Inchrdf pedrd 40 CFR 266,40 m4twuf bnpannlss bio ddudon MUro profdbRed wasPe, T am avrare that !hero aro sfgnlricsnf prnapfoa for aubmtitbngaMe
<br /> rp MAW
<br /> (CEFrT7FlCATIONAEMOVED BYPIPASEtu)
<br /> GOOD FAITNMOAtaALYTICAL CEflTTFdCATIDN - FOR UtCiNEAATE0 OAGANPCS
<br /> t Certify undcrponatty oPinw tical havo personallyaxomindaad am hmtl Cir tnlh lho hoatmonf fadvraPogy and apam0on of Cho raa(menl pr000 s usedPo supped this addrtaVadBasad
<br /> an myktqutry at Ihesa fnd(viduah ynmar0ataty rosponslble ioI obioinbay 03 Informatlan, I IloUovc that the nonwasfawntcror4antc wnsUtucnfs havo loon troalod by conAus9ar oats as
<br /> spccf8d lir 26B.d2, TabPo 8, t havo boon unabfa la rkfact the nonwasto Wolof or4anto tnnsUtuon(s, dosp((a haying used bast god falUr o8orts Po analyze for inch wnsdNonls, I am swam
<br /> )het Chore are
<br /> sfgnffieantponaltloseraubmlldngofalsoced(6wUonkrdudfnpUapossbpiiyofUnaandtmpdsonmenP."
<br /> DEC
<br /> ffARAC1ERtYE0 WASTE REOUIRES TREAThtEryT FOR UNDERLYING IfAZAR00US CON
<br /> I Cortrs underpnnalty o( tawthnf lha westa has boon ucatd &r aawrdonce WtIl a raqurramants of 40 CFR 266.40 fo remove Cha haznrdays charocterhUc TNs dncfiamda rtedwaslo
<br /> eenlahts undartyinghazardals eoruUfuanis Uro! raqu¢a funhortroa(mant to moot untvenal uoatment starxiarda, f am aware that there are sfgn!(kantpena(das for submtaai9 a false
<br /> 0enlrrcattan, inefuding
<br /> Ma
<br /> passUty of
<br /> Una and im lisonma ,
<br /> RESTAfCTEO WASTE SUBJECT TO A VARIANCE
<br /> This Warre Ls subject to a national Capacity vadanca, a tntalabNly variance, ora wso •by.eoso oxionston. Entortho aN°ctIvo data of ProMf fon to column 5 above,
<br /> O Farfrazordorrs debris: 'Ws hazardous dabds is subject to the alternative froatmani standards 0140 CFR MAV
<br /> RESTRICTED WASTE CAN BE LAND DISPOSED WITHOUT FURTHER TREATMENT
<br /> exandnad and am
<br /> the waste comp ass Kirk the tfundarpealy allow ihat Ituwa°atmentstanda asy ad h7 40 CFR Pah 260 Subpart D. ttbano ethat the Inrormodon t ats ubmllteor d Is Uuo, aoccurate and compete* I am aa of (he waste to utippoll ware tl ® t
<br /> stgnit cant penalties for subndding a raise c liticnti0n, indudlny Uro possUly of a Pubo and imprlsonmenL®
<br /> WASTE HOT CURBENTLY SUBJECT TO ("ART 260 REsm(CTIONS
<br /> this waste is a newly klan0lod waste that Is not Currently subject to any 40 CFR Part 266 rostdgtons,
<br /> iW mat all w0arnapon to this and Ali a ssadatad doeumonrs Is comproto and acwtal°, to the Nil army knowledge and tnrormnitan,
<br /> GENERATOR COPY trTwteaEs tali
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