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:E_=11 <br /> LAND DISPOSAL~ RESTRICTIO�,4 NOTIFICATION FORM page 1 of <br /> For Wastes Subject to the Treacmcnt Standards Founu in 40 CFR 268 <br /> Generator'Name: -11 ZVN Manifest No <br /> WMDS WW/NWW Waste Codes,Subcategories and Hazardous Constituents' Special <br /> Conditions <br /> SE � i <br /> 'For waste steams that carry the FPA waste codes FOO 3-FOOS,and F'039,the Regulated Hazardous Constituents(found in 40 CFR Part <br /> 268.40)must be identified. For waste steams that carry the EPA waste codes D001 (if Not Treated by Cs'vIBS"T or RORGS),D002-D043 <br /> (if treated in;Von-CWA,Non-CWA equivalent or,Non-SDWA facilities),the Underlying Hazardous Constituents(UHC's)must be <br /> identified.[wastewater forms ofD012-DOt7 do riot require tha(UHC's be identifred.j List the constituents on the corresponding line or <br /> include a marked copy of the Form G-FO505 for each WNIDS. <br /> Special Conditions: <br /> A. Waste Requiring No Further Treatment <br /> B. Lab Pack Waste Qualifying for Alternative Treatment under 40 CFR 268.42(c) <br /> C. Hazardous Waste Debris subject to standard treatment requirements,40 CFR 268.40 <br /> 0. Hazardous Waste Debris subject to alternative standards in 40 CFR 268.45 (List Contaminants) <br /> E. Waste Qualifying for Exemption and not subject to Land Disposal Restriction(Explain) <br /> F. Characteristic wastes that are subject to the treatment standards in §268.40(other than those expressed as a required <br /> method of treatment)that are reasonably expected to contain underlying hazardous constituents as defined in §268.2(i);are <br /> treated on-Site to remove the hazardous characteristic;and are then sent off-site for treatment of underlying hazardous <br /> constituents(List constituents). <br /> G. Characteristic wastes that contain underlying hazardous constituents as defined §268.2(i)that are treated on-site to remove <br /> the hazardous characteristic and the underlying hazardous constituents to levels in §268.48 Universal Treatment Standards. <br /> H. For Chemical Manufacturers, Petroleum Refineries, Coke By-Product Fa6lities'and RCRA TSDFs handling wastes subject to <br /> 40 CFR 61 subpart FF ONLY: This waste is a"Controiled Benzene Waste"which is subject to the notification requirements of <br /> 40 CFR 61 subpart FF. <br /> L Certification for contaminated soil indicating the presence or absence of characteristic and 1 or listed hazardous wastes. <br /> J. Certification for contaminated soil treated in accordance with 44 CFR 268.49. <br /> Waste analysis is attached where available, otherwise, the information contained herein is based <br /> upon my thorough knowledge of the wastes). <br /> hereby certify V-+ r�-'ievc that the information 1 submitted is true,accurate and complete. <br /> Signature Title Al Da� <br /> Applicable certification language included on page 2 of this document. <br /> F-0152;Rev:2-Land Disposal Restriction Notification Certification Form <br />