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Sterloycle Environmental Sol"norts <br /> RCRA Land Disposal itestrietion Notfjlcatlon Farn: <br /> Generator: Work Order <br /> i US EPA ID <br /> PSC Profile No. <br /> NO. (� <br /> --(; Manifest���� �C4� <br /> No. <br /> Zn accordance With 40 CFR 266.7(a), rhe rrndellying hazardous constituents rrtrr <br /> ?68.Z(i), "ttnder'lyhrg hazardous constituent"means any constituetrt listed In 268.98 Table UTS <br /> st be addressed iia tills waste. Per <br /> Standard lvhiclz can reasonably be erpected to be present at the polio of generation of the hazardous was <br /> carcentration above the constituent specific UTS treaturent starrdat rl Refer to.Form of (attachedet for <br /> waste <br /> at a <br /> code(s), treatability group and strbcate or applicable to this waste te, at a <br /> �' Y pp )f the waste <br /> In ode"to address underlying hazard <br /> orrs constitrtetus in ciim•acteristic wastes,please check thea ro tf <br /> C3 have reviewed the UTS list of 268.48and .7{a),I have determined thPp p ate boa: <br /> , per 268 <br /> underlying hazardous constituents reasonably expected to be present in this Waste. ere are no <br /> *I have reviewed the UTS list of 268.48, and per 268.7 <br /> hazardous constituents are present in this waste. The under have determined that underlyvig <br /> identified as follows: underlying hazardous constituents are <br /> The determination ofunderlying hazardorrs constituents was based on: <br /> C7 Generator's knOWledge of the waste <br /> Analysis <br /> I certify that I personally have-examined and am familiar with the to throu <br /> knowledge of the waste to support this certiScation.I cern s <br /> analysisand <br /> of and testing'or through <br /> named above,all the information submitted in this noti <br /> uthorized representative--� <br /> s e and correct to the best of to the generatorY knowledge. <br /> Printed Name <br /> Signature <br /> C4- Da e <br /> Form EZ Revised 07/31/9S <br /> This is a two sided form <br />