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P3genium- IIAZARD-HERUES LAND DISPOSAL RESTRICTION NOTIFICATION FORM For Wastes Subject to the Treatment Standards Found in 40 CFR 268 Generator Name: Kelly Moore Paint Company WW NWW Approval # ❑ 0 22132612 Order:659697-07 (E) Manifest No:000514407DAT EPA Waste Codes / Underlying Hazardous Constituents LDR Code D001 F ❑ 0 22136086 E LDR CODE A. Restricted Waste Meets Treatment Standards (40 CFR 268.7(a) (3)) The restricted waste identified above meets the treatment standards in 40 CFR 268.40 or Alternative LDR treatment standards for contaminated soil 40 CFR 268.49 and can be landfill disposed without further treatment. I have attached all supporting analytical data, where available. I certify under penalty of law that I personally have examined and am familiar with the waste through analysis and testing or through knowledge of the waste to support this certification that the waste complies with the treatment standards specified in 40 CFR Part 268 Subpart D. I believe that the information I submitted is true, accurate and complete. I am aware that there are significant penalties for submitting a false certification, including the possibility of a fine and imprisonment. Restricted Waste Treated To Treatment Standards (40 CFR 268.7(b) (1) and 268.7 (b) (2)) The treatment residue, or extract of such residue, or the restricted waste identified above has been tested to assure that the treatment residues or extract meet all applicable treatment standards in 40 CFR 268.40 and/or performance standards in 40 CFR 268.45. 1 have attached all supporting analytical data, where available. I certify under penalty of law that I personally have examined and am familiar with the waste through analysis and testing or through knowledge of the waste to support this certification that the waste complies with the treatment standards specified in 40 CFR Part 268 Subpart D. I believe that the information I submitted is true, accurate and complete. I am aware that there are significant penalties for submitting a false certification, including the possibility of a fine and imprisonment. C. Restricted Waste With Technology Based Treatment Standards (40 CFR 268.7(b) (4)) I certify under penalty of law that I personally have examined and am familiar with the treatment technology and operation of the treatment process used to support this certification and that based on my inquiry of those individuals immediately responsible for obtaining this information. I believe that the treatment process has been operated and maintained property so as to comply with the treatment standards specified in 40 CFR 268.40, without impermissible dilution of the prohibited waste. I am aware that there are significant penalties for submitting a false certification, including the possibility of a fine and imprisonment. D. Restricted Waste Decharacterized But Requires Treatment For UHC (40 CFR 268.9) I certify under penalty of law that the waste has been treated in accordance with the requirements of 40 CFR 268.40 to remove the hazardous characteristic. This decharacterized waste contains Underlying Hazardous Constituents (UHC) that require further treatment to meet the universal treatment standards. I am aware that there are significant penalties for submitting a false certification, including the possibility of a fine and imprisonment. E. Restricted Waste Subject To Treatment (40 CFR 268.7(a) (2)) The restricted waste identified above must be treated to the applicable treatment standards in 40 CFR 268.40, or treated to comply with applicable prohibitions set forth in Part 268.32 or RCRA Section 3004(d). I have attached all supporting analytical data, where available. F. Hazardous Debris Subject To Treatment (40 CFR 268.45) This hazardous debris identified above must be treated to the alternative treatment standards in 40 CFR 268.45. G. Restricted Waste Subject To A Variance or Extension (40 CFR 268.7(a) (4)) This restricted waste identified above is subject to a case by case exemption under 40 CFR 268.5, an exemption under 40 CFR 268.6 or a nationwide capacity variance under Subpart C of 40 CFR 268, and is not prohibited from land disposal. LDR prohibitions become effective on (date) for this restricted waste. The corresponding treatment standard(s) are promulgated in 40 CFR 268.40. 1 have attached all supporting analytical data, where available. H. Restricted Waste Managed In A "Lab Pack" (40 CFR 268.7(a) (9)) I certify under penalty of law that I personally have examined and am familiar with the waste and that the lab pack contains only waste that have been excluded under appendix IV to 40 CFR Part 268 and that this lab pack will be sent to a combustion facility in compliance with the alternative treatment standards for lab packs at 40 CFR 268.42(c). I am aware that there are significant penalties for submitting a false certification, including the possibility of a fine and imprisonment. I certify and warrant that the Information that appears on this form, and appended documents, is true and correct. I have correctly indicated how my waste is to be managed in accordance with 40 CFR 268. My certification is based on personal examination of the information submitted, or is based on my inquiries of those individuals responsible for obtaining the Information. Authorized Signature: Title: Date: P—ered by e V✓A aTIeLINQ