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Clean Earth EsrvirournentalSolutions <br /> RCRA Land Disposal Restriction lkatifrcation Fornt <br /> Work Order # <br /> Generator: <br /> US EPA ID <br /> 1 ,;j <br /> Profile No. No. a&,cQQCq <br /> �� ... Manifest <br /> NO. 0935n- I�D�a K <br /> In accordance with 40 CFR 268.7(a), the underlying hazardous constituents must be addressed in this waste. Per <br /> 268.2(1), "underlying haaardous constituent"means any constituent listed to 268.48, Table UTS--Universal Treatment <br /> Standard which can reasonably be expected to be present at the paint afgej?QrAfion of the ha�ardotrs �s'aste, at a <br /> concentration above the constituent-specific UTS treatment standard! Refer to Form-EZ (attached)for the waste <br /> code(s), treatability group, and subcategory applicable to this waste. <br /> in order to address underlying hazardous constituents in characteristic-H,astes,please check the appropriate box: <br /> I have reviewed the UTS list of 26 8.48, and per 268.7(a), I have determined that there are no <br /> underlying hazardous constituents reasonably expected to be present in this waste. <br /> ❑ I have reviewed the UTS list of 268.48, and per 268.7(a), I have determined that underlying <br /> hazardous constituents are present in this waste. The underlying hazardous constituents are <br /> identified as follows: <br /> The determination of underlying hazardous constituents was based asr: <br /> 0 Generator's knowledge of the waste <br /> 0 Analysis <br /> I certify that I personally have Examined and am familiar with the waste through analysis and testing,or through <br /> knowledge of the waste to support this certification.I certify that as an authorized representative of the generator <br /> named above,all the information submitted in this notification is true and correct to the best of my knowledge. <br /> Printed Name Signature <br /> Date <br /> CUA-�-4� Co-" <br /> Form EZ Revised 07/31/98 <br /> This is a two sided form <br />