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06 / 11 / 2021 1 : 47 PM FAX 2499488625 ANCE SAW [a] 0004 / 0007 <br /> �terr�vcte f nvirotrinental ,Solutions <br /> IN Land ,Disposal ltesi'rittioll N01lfieatlot: Forttr <br /> Work Order W <br /> Generator: = t ' US EPA I WWI <br /> IN all <br /> t� <br /> PSC ,ProfileNo & {j Manifest <br /> No# cokmfi 9&f <br /> In aeca)"dance with 40 CFR 243. 7(x), the tinder•lyzV 11amrdoziscor7sfituents )trust be addressed in this waste, Per <br /> 66, 2 (1), "Underlying hazardous COnstittlent " nielans any Constiluent listed in 268. 48, Table UTSUniversal Treatment <br /> Standard which can reasonably be ae €ated to be Ir+ went at the point Of 99nel'atidn oj' the hazardous miaste, at a <br /> concentration above the constituent-speclOc UT,S treatrrrent standard, Refer to Form-EZ (attached) foil the waste <br /> Code ( }, trolecrtability group, and subcategory applicable to this wasrs. <br /> In order to add,•ess tlnderl)? ' hazardous constituents in characteristic wastes, please check The appropriate box: <br /> �) I have reviewed the PUTS list of 269 .48, and per 268 . 7 (a), Z have determined that there are no <br /> underlying hazardous constituents reasonably expected to be present in this waste. <br /> ' I have reviewed the PUNTS list of 268 .48 , and per 268 . 7 (x), I have deterjriined that underlying <br /> hazardous constituents are present in this waste. The underlying hazardous coz>.stitiwnts are <br /> identified as follows _ <br /> L"170 deWlnination of underlying hasardcrrs cottstittlents was based orl: <br /> MY Gener'ator's knowledge of the waste <br /> d Analysis <br /> I certify that I personally have examined aid am familiar with the waste through analysis and tegting, or tbrough <br /> lrnowledge of the waste to support this certificatioIll <br /> n . I certify that as an authorized representative of the generator <br /> narned abovve Nall' the b)formation submittedtin I NIPti) is notifioation is true atnslIN oil, Ile , corxeotto the best of knowledge, <br /> I ON <br /> PON I <br /> IN IN 1 <br /> N.NNPrinted Name Signature <br /> Date <br /> WshW <br /> Form B2 Revised 07/3119$ This is it two sided form <br /> I <br />