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S/ Applicable Certifications PART III. Authorized Re resentative Crosby&Overton PmMe Number 2vlanifest and Linc Item Number associated with wash shipment . 51192 000252916 JJK 9b.1 CHECK THE APPROPRIATE CERTMCAT10N 1. Genemtor`s Cerdfacation(268.7(a)(2)(ii))for waste that meets Treatment Standards 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,fart 268 Subpart D and all applicable prohibitions set forth in 40 CPR 269-32 or RCRA Section 3004(d). I believe that the infomation 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. 2. Waste Treated to Remove Characteristics(268.7(b)(5)(iv)) 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&zharacterized waste contains underlying hazardous constituents that require further treatment to meet universal treatment standards. I am aware that there are significant penalties for submitting a false certification including the possibility of fine and imprisonment 3. Debris Treated to meet Alternative Standards(Z68-7(d)(3)(Ri)) I certify under penalty of law 1hat the debris has been treated in accordance with the requiremezats of 40 CFR 268.45. I am aware that there are significant penalties for making a false certification including the possibil*of true and hUpriscnment. 4_ Lab Packs to be Treated by Incineration(Certification must be completed_)Appendix IV Lab Packs I certi.Y under penalty of law that I have personally exaunined and am familiar with the waste and that the lab pack contains only wastes which have not been excluded under Appeadix IV to 40 CFR Part 258 or solid wastes not subject to regulation under 40 CFR Part 251_ I am aware that there are significant penalties for submitting a false certification, including the possibility of fine or hziprisonment 5. Appendix V Lab Pack: I certify under penalty of law that I personally have examined and am familiar with the waste through analysis testing or through Imowledge of the waste and that the lab pack contains only organic waste specified in Appendix V to part 268 or solid wastes not subject to regulation tinder fart 261. I am aware that there.are significant penalties for submitting a false certification,including the possibility of fine or mmprisoruuertt Signature t Print Name-, Date Title 3 of 5