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uvA. nuc CUU0 O: 11 /H19 L,HtMiUHL.. WH51t MHNHULMLNI bb`.3' jEibbiuE} p. 3 CCflF1'JWXK M BOILS WAV DIBPOBAL NC'IIFICATTCV AMD Clg)MMATIOH FORM Generator Kamen �- - manifest Doc. P(o.I ' Pmf-la Mawars state Manifest Wei 1. Is this waste a non-wantswaterr4 (See 66 CFA 268.2) Cheo'c one, Wenwaetewnter ..wastewater 2. (C:RCLB) Thin contaminated moil .does/does not> contain listed hazardous waste and (doss/does actn. exhibit a oharaoteristic of hazardous waste and cis subject to/coaplisa with* the soil treatnient Standards as provided by 40 GFR 268.49(c) or the Un vereal Treatment Standards. 7. Identify ALL MMM hasardous waste 00408 that apply to this wast* shipment, me defined by 4.0 CFR 2dl. For each waste code, identify tie corresponding subcategory, or cheek NONE if the waste code has no subcategozy. ipemt solvent tzeatment stsadszds are listed on the following page. If F031, '.Ulti-scums lssohate applies, those oonstituenta present in - soil Met be SiAbd and attached by the ganotatexz. If DOol-DO43 and/or listed waste, requires treatment of any applicable Characteristics and meet$ 268.48 standards, then the unlerlying constituent(e) in the treat& must be listed and attatobed. 4. US SPA 5. SUSCATE3MY b. PON MtBT RAFT }}A(dARDOt18 ISR THE S03CATEOORY CCSCRIPTION, THE Maters $ 6 CM ODS 1115 SM6} Ji(i !S`RNM Urrm BELOW 1 2 To .1datntify F039, DO0 •D043, or 4&1 underlying hazardous coaat tuent n , use y rgffasazdos Cbnatituent Form. pravidod (CNK-2004 ) and cheek hare: If no (A(Ca are present in the waste mon its initial generation e on check her To list additional MEM waste code(s) and suboatsgosie(a), urs the supplemsmal shoat provided and check here, tree will n s and re, XW NCJST TEE 4JABTE BE f4 D7 In column d *bow, enter the letter (A.1, 9.5, or I) below that describes how the waste must be managed to comply with the land disposal regulations (40 CFR 258.7). Please understand that if yens enter the Sottas A.3, B.S. D, or B, you are raking the appropriate certification ae provided below. States authcrized by EPA to manage the IDR program may have reg'ilatory citations different from the 40 CPR citations listed below, where therm regulat:omy citations differ, your certification will be deemed to safer to those state citations instead of the 40 CFR Citations. A.i RE SAIL RSQV=a TR (Circle) . "I certify under penalty of law that I personally have examined this zonteninated mail and it .does/ not;, contain listed bazartious wastes and cdoaa(does not- exhibit a characteristic o! hazardous .waste and requires treatment to most the soil traatmnt standaxda as provided by 40 CPR 268.49(01." 2.5 R882RZ SOIL VICAMID TO AiaTERI}AT$ HMFcK4M= STAtDAM "I certify under penalty of law that I }nays personally examired and am faedl:ar with the treatment technology and operation.of the treatment prooess used to support this certification " believe that At bas been maintained and operated properly so as to eos®ly with treatment standards specified In 40 CSR 268.49 without impermissible dilution of the prohibited wastes. I am ova" there are significant penal:las for submitting a false certification, including the possibility-of fine and 3mpridocnesut." D. FSSTRICttSm IFIL CAN BE LMM DISPOSED WITMW FORMUR TRBATMMM It certify under penalty of law that I personally have,esaalaed and am familiar With the waste through analysis and testing or through knowledge of the waste to *%V rt this certification that.the waste eonplies with the treatment standards specified in 40 CM 368 subpart D. I believe that the infoa-nation I aubaitted I$ true, accurate, and complete. I Ow.aware there are significant penalties for svbdtting a false cartificatlon, including the possibility of fins and imprisompent.a E. SOIL I8 NOT CLMEW'1T,Y ofti M To PART 268 vZMjCTIOpS This waste is a newly identified wants that ie not currently aubfect to any 40 CPR 969 Part rostrietiens, cert t a. orfidt on a s e a assoo ate cum® s s oemgn rte a accurate, to est a£ wry knowledge and information. aiSR+atmre rule Date rMW CM4-2005-E (9(9gi t