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r u LAND DISPOSAL RESTRICTION ( LDR) NOTIFICATION AN WASTE MANAGEMENTCERTIFICATION FORM ( PHASE IV) A GeneratorName : Profile Number: Cateivok O)eq Manifest Number: Oki ( 2 . US EPA HAZARDOUS 3 . SUBCATEGORY ENTER THE SUBCATEGORY DESCRIPTION 4 . HOW MUST THE WASTE Ref. # WASTE CODE (s) (If not applicable, simply check NONE ) BE MANAGED ? ENTER LETTER DESCRIPTION NONE FROM BELOW 2 . 3 . 4. 1 . Is this waste a non -wastewater or wastewater? (See 40 CFR 268 . 2 ) Check ONE: CXNon-Wastewater ❑ Wastewater For hazardous debris meeting the definition of debris and subject to the alternate treatment standards in 268 .45, check here : ❑ 2 . In column 2, identify ALL USEPA hazardous waste codes that apply to this waste shipment, as defined by 40 CFR 261 . • To list additional waste code (s) use Land Disposal Notification/Certification Supplemental Form (CWM-2005- D ) and check here : Cl 3 . In column 3 , for each waste code, identify the subcategory if one applies, or check NONE if the waste code has no subcategory. 4 . In column 4, enter the Letter from the list below (A . — D.) that describes how the waste must be managed to comply with the land disposal restriction regulations in 40 .CFR 268 . Please note that if you enter B . 1, B. 31 B. 6 or D, you are certifying that the waste meets all the Land Disposal Restrictions and may be landfilled without further treatment. If you enter B .4, you are certifying that the waste has been decharacterized, but still requires treatment for UHCs . (States authorized by EPA to manage the LDR program may have regulatory citations different from the 40 CFR citations listed on this form . Where these regulatory citations differ, your form will be deemed to refer to those state citations as well as 40 CFR . ) 5 . Constituents of concern for waste codes F0014005 and F039 and underlying hazardous constituents ( UHCs) for D001- DO43 , must be identified unless the treatment facility will monitor for all constituents . If any of these codes apply, check appropriate box below: • To identify constituents of concern for F001 - F005 , F039 and UHCs, use the Identification of Constituents of Concern f�n a�i . cwk re : ❑ • If UHCs are applicable, but none are present at the point of generation , check here : ❑ .. • If incineration facility will monitor for at[ constituents of concern (except dioxins) , check here: ❑ MANAGEMENT METHODS AN 25 201 $ A RESTRICTED WASTE REQUIRES TREATMENT This waste must be treated to the applicable treatment standards set forth in 40 CFR 268 .40 . B . 1 RESTRICTED WASTE TREATED TO PERFORMANCE STANDARDS �NVIRON (UI ) "I certify under penalty of law that I personally have examined and am familiar with the treatment technology and o qp f4k1ffiVAme1hWp�rocess used to support this certification . Based on my inquiry of those individuals immediately responsible for obtaining this information , I believe that the treatment process had been operated and maintained property so as to comply with the treatment standards specified in 40 CFR 268 . 40 without impermissible dilution of the prohibited waste. I am aware there are significant penalties for submitting a false certification including the possibility of fine and imprisonment." B . 3 GOOD FAITH ANALYTICAL CERTIFICATION FOR INCINERATED ORGANICS "I certify under penalty of law that I have personally examined and am familiar with the treatment technology and operation of the treatment process used to support this certification . Based on my inquiry of those individuals immediately responsible for obtaining this information, I believe that the non - wastewater organic constituents have been treated by combustion units as specified in 268 .42 Table 1 . I have been unable to detect the non -wastewater organic constituents despite having used best faith efforts to analyze for such constituents. I am aware that there are significant penalties for submitting a false certification , including the possibility of fine and imprisonment. " B .4 DECHARACTERIZED WASTE REQUIRES TREATMENT FOR UNDERLYING HAZARDOUS CONSTITUENTS "I certify under penalty of taw that the waste has been treated in accordance with the requirements of 40 CFR 268 .40 or 268 .49 , to remove the hazardous characteristic. This de-characterized waste contains underlying hazardous constituents that require further treatment to meet treatment standards. I am aware that there are significant penalties for submitting a false certification, including the possibility of fine and imprisonment." B .6 RESTRICTED DEBRIS TREATED TO ALTERNATE PERFORMANCE STANDARDS "I certify under penalty of Law that the debris has been treated in accordance with the requirements of 40CFR 268 .45 . I am aware that there are significant penalties for making a false certification, including the possibility of fine and imprisonment." C. RESTRICTED WASTE SUBJECT TO A VARIANCE This waste is subject to a national capacity variance, a treatability variance, or a case- by- case extension . Enter the effective date of prohibition in column (4) above. D . RESTRICTED WASTE CAN BE LAND DISPOSED WITHOUT FURTHER TREATMENT "I certify under penalty of law I personally have examined and am familiar with the waste through analysis and testing or through knowledge of the waste to support this certification that the waste complies with the treatment standards specified in 40 CFR Part 268 Subpart D and LAC 33 : V. 2223- 2233 . I believe that the information I submitted is true, accurate and complete. I am aware that there are significant penalties for submitting a false certification , including the possibility of fine and imprisonment." I hereby certify that all information submitted in this and all associated documents is complete and accurate to the best of my knowledge and information . Name : ( Print) //�' /d/ �1 f7`.� 1� Title : Signature : �� Date : X2007 Waste Management, Inc . CWM - 2005 -C August 2007