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Applicable Certifications <br /> PARI'M. Authorized Representative. <br /> Crosby&04erton Profile Number M=ifest and Linc ltam Number associated with wasta shiimrnt . <br /> 51192 000252725JJK 9b :1 <br /> CHECK THE APPROPRIATE CERTIFICATION <br /> 1.Ii Generator's Certification(268.7(a)(2)(ii))for waste that meets Treat inent Standards <br /> 4 I certify udder penalty of law that I personally have examined and am familiar with the waste through analysis <br /> i and testing or through kaowledge of the waste to support ibis certification that the waste complies with the treatment <br /> I�standards specified in 40 CFR,Part 268 Subpart D and all applicable prohibitions set forth in 40 CFR 26832 or RGRA <br /> :Section 3004(d). I believe that the infomation I submitted is true,accurate and complete. I am aware that there are <br /> significant penalties for submitting a false certification,including the posstW*of a fine and imprisonment <br /> 2. Waste Treated to Remove Characteristics(268.7(b)(Wiv)) <br /> I certify under pahty of law that the waste has been treated in accordance with the requirements of 40 CFR 268.40 <br /> emto <br /> F. <br /> remove thhe bazatdous dmmcterisfic. 11M dwlaiar�ized waste contains underlying hazardous c;onstitnents that <br /> require further treatment to meet universal 6reatmeat standards. I am aware that dxere are significant penalties for <br /> €,submitting a false certification inc inn the pom-bMV of fine and imprisoziment. <br /> 3. Debris Treated to meet Alternative Standards(268.7(d)(3)(ib)) <br /> I cert fy under penalty of law that fe debris has been treated m accordance with the requirement of 40 CFR 268.45. I <br /> am aware that 6=are significant penalties for making a false cer0.cation including the possrbril y of fine and <br /> imprisonment. ` <br /> fa <br /> 4. Lttb Packs to be Treated by Incineration(Certificati(M MUA be completed.)Appendix IV Iib Packs <br /> I certify under poneay of law that I have personally examined and am famil with the waste and that the lab pack <br /> contains only wastes winch have not Keen c chided under Appendnx'IV to 40 CFR Part 268 or solid wastes not wblect <br /> �o regulation uookr 40 CFR Part 261. I am awaxe that there are siert penalties for submitting a false certification, <br /> incbmlmg the potss.ibi ity of f=or imprisonment. <br /> 5 Appendix V Lav Pack: <br /> I cmtify under penalty of law that I personally have examined and am familiar with the waste through analysis testing or <br /> � <br /> ib�ngh hmowl a of fire waste and that the lab pack contains only organic waste specified m Appendix V to part 268 <br /> or solid wastes not subject to re under Part 261. I am aware that there are significant ties for shitting a <br /> ] �o'n � � <br /> false mon,iuchnhg the possibility of free or impusaammt. <br /> Siguatr�re Print Name <br /> - <br /> Title <br /> 3 of.5 <br />