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PROFILE CERTIFICATION <br /> I hereby certify that(1)all information submitted on this form and on supplemental materials is complete and accurate to the best of my knowledge and ability to <br /> determine;(2)the information provided herein,including any supplemental information,such as laboratory analytical,MSDS,etc.,accurately describes the waste stream to <br /> be delivered to the facility and that all known or suspected hazards have been disclosed.I understand that,once the waste stream is approved by Destination Facility based <br /> on this information,any deviation in the source,composition,constituents or characteristics of the waste stream from the information described herein,may render the <br /> waste stream unacceptable for disposal,at the sole discretion of Destination Facility.I further understand that any deviation from the information contained herein will <br /> require immediate notification to the Destination Facility and cessation of disposal. <br /> Signature a 6� L/0tV%[,6 W <br /> Printed Name Tammy Domgaard <br /> Date 11/24/2020 <br /> Company Ancon <br /> Title <br /> ----------------------------------------------------- ----------------------------------------------------------------- <br /> PROFILE APPROVAL <br /> status: approved <br /> Approval#: PHLF-20-925 <br /> Approved By: Darren Hansen <br /> Approved On: 11/24/20 12:00 am PST <br /> Expires On: 11/24/21 12:00 am PST <br /> Approved volume: 4 cubic yards <br /> Approved Disposal Methods: NH001 <br /> Conditions: Approved for burial <br />