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LI LAND DISPOSA-L" R.ESTRICTIC) NOT1!=ICATiON rORtif page 1 of For' zsres Subject to the Treatrment Standards Found in 40 CFR 368 i Ge.eratar Name: -1 P G V t i 2 Y1 l gz)U-4v ti WNIDS %Aiw/N Ww W"as=.c Codes, Subcategories and Hazardous Constituents" Special � Conditions it 1/F—I Il , 'For waste steams that carry the EPA waste codes F0014005,and F039, the Regulated Hazardous Constituents(found in'40 CFR Part 258.40) rn"ust he identified.For waste steams that carry the EPA waste codes D001 (if Not Treated by C 1BST or RORGS),D002-D043 - (if treated in:'Von-CWA,-Non-CWA equivalent or tion-SDWA facilities),the Underlyin.9 Hazardous.Constituents(l HC's)must be idcntiGed.'L Nastewate�forms ofDOIZ-D"vii do not require that UHC's be identifred.j List the constituents on the corresponding line or include a irnarked copy of the Form C-F0505 for each WMDS. Special Conditions: _ - A. Waslte Requiring No Further Treatment B. Lab Pack Waste Qualifying for Alternative Treatment under 40 CFR 268.42(c) C. Hazardous Waste Debris subject to standard treatment requirements, 40 CFR 268.40- 0. Hazardous Waste Debris subject to alternative standards in 40 CFR 268.45 '(List Contaminants) E. Was Qualifying for Exemption and not subject to Land Disposal Restriction (Explain) F. Chal7acte.ristic wastes that are subject to the treatment standards in §266.40.(cther than those expressed as a required method of treatment)that are reasonably expected to contain underlying hazardous constituents as defined in §268.2(i);are . treated ort-site to remove the hazardous characteristic; and are then sent off-site for treatment of underlying hazardous constituents(List constituents). G. Characteristic wastes that contain underlying hazardous constituents as defined § 268 2(i)that are treated on-site to remove the Hazardous characteristic and the underl"ying hazardous constituents to levels in §268.48 Universal Treatment Standards. H ForiChemical Manufacturers, Petroleum Refineries, Coke By-Product Facilities and RCRA.TSDFs handling wastes subject to E 40 CFR 61 subpart FF ONLY;This waste is a"Controlled Benzene Waste"which is subject to the notification requirements of 40 GFR 61 subpart FF. L Certification for contaminated soil indicating the presence or absence of characteristic and!or listed hazardous wastes. ii 1, Certification for contaminated soil treated in accordance with 40 CFR 268.49. i F Waste analysis is attached where available, otherwise, the information contained herein is based i upon my thorough knowledge of the waste(s). I herebycertify that t�- Sr that the information f submitted is true,accurate and complete: t ,F Signature Title 4 Da p /5 Applicable certification language included on page 2 of this document. F-0152;Rev:2-Land Disposal Restriction N'OGFICetion Certif cation Form i3