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V-50. <br /> OMB#; 2050-0175 ares 12/31/2003 <br /> EPA ID No. I_t <br /> S. Waste Codes for State-Regulated Q.e.,non-Federal)Hazardous Wastes. Please list the waste codes of the State-regulated hazardous wastes handled <br /> at your sit& list them in the order they are presented in the regulations. Use an additional page if more spaces are needed for waste codes. <br /> 12.Comments(See Instructions on page 31) <br /> r <br /> 13. Certification. I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a <br /> system designed to assure that qualified personnel properly gather and evaluate the information submitted.Based on my inquiry of the person or persons who <br /> manage the system,or those persons directly responsible for gathering the information,the information submitted is,to the best of my knowledge and belief, <br /> true,accurate,and complete.I am aware that there are significant penalties for submitting false information,including the possibility of fine and imprisonment for <br /> knowing violations. (See Instructions on page 31) <br /> Sig ature of owner,operator,or an Date Signed <br /> authorize a esentative Name and Oficial Title(type or print) (mmfdd/yyyy) <br /> to <br /> 1. 9PA Form 8700-12 (Revised 5/2002) Page 3 of 3 <br />