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<br /> PART ITT, Authorized Re ]rescntaUve
<br /> Cfusl,y&Qvt;rrnn Prorrlo Numhur
<br /> ltunifcs[and Linc!'cm t•l,lrnt, r ,r,;,•r�arr•:;;irlr wnsG sir pcs�ru
<br /> 51192
<br /> 23759052 11,a
<br /> �z
<br /> CHECK THE APPROPRIATE CERTIF ICAT I ON
<br /> 1. Generator's CC,-t1nr_atl0n (268,7(2)(2)(11)1 for Syjjsfe t1[;lt nic¢:ts Treatmetrt 4t,trrti,trtls
<br /> I certify undo penalty of Yaw that I j.Lc sally=11 the exal,tined 11110 ant faurifi lr lvifb I'rir;i_]ste tlucur [t arta! si
<br /> I,-
<br /> and testing or Wroul;h krtolvlcrlgc of file}vasle In sirpl,ort (lrir,cc.tlific:zi[t711 Iltat We (t astr rarr[plics lvt[ls n-al [ria
<br /> standards specified in 40 CFR, Part 268 ul?part.l�and aC[alJl]licaGla ptolril,iLiorta ser Cur(11 if-14-0 � LhcY s
<br /> Section 3{)D4 tl . ttltcnf
<br /> { ) I Uclicvc that 1}]e inrrtrnit{lir,[l 1 subini[tea is true, acctlra(c arrrl cnttrillcic. 1 n la[v arfcFW r[there are
<br /> ssgificantpenalties for subrrdtting a fafsc rertificatiorl, irtc[;[t11u
<br /> 2, Waste 1']ca[erl to Ztenstrve C:lrnrrr.t.r!tl.sl[cs (2G$.7(l�)(5){;}•)) []os.ibilily e7Ca Rift: and hnprisur,rrrcrtt.
<br /> I certify under enal
<br /> p ty of Inzv (f3a[ tlrc wr,sic has bt! [tenlr•rl itr nc�asrtla�cec}villi (tet:rcr srir�
<br /> remove file Ita7asdous characteristic. This de,clraracterizer[1vrt.s[e
<br /> require further treatment to ascot tuallcrsal [rct,[,steut•s[anclar L cclrs[airrs u]rcic rl�irr0 l a::rltt[uustcunsfi(t Prtis ul[nr40 CUR 3.40 lc,
<br /> submitting a false ccriificalian inc(lrriirr , We lossibflit y `' i ars, at'.arc (bat [[+cr<<rrr.•sfyui�crtrrt ppnaltie5 fiir
<br /> !? I of lirlc and irnprisorlrrrerlt.
<br /> 3. Debrls'1~reafetl to meet Alterrsaf-ivc 5[;lnll lrtls(264.7(,])(3}(lIi))
<br /> I ccaway turtlr;r tau]=ally uf1�}v tJt rt iltc dcfar�s Iras U.:cn trea[eLI ill aecvrL7ancc wiCL rlrc+�.ltrjtt:lr+�,rr� of {7 CE 7r
<br /> arrr aware that((sere are signi�cat](Penallics for Making a rake cel-IMICaliutr iuclurlite�
<br /> irzlprisonnsout.
<br /> s ,.-t• ttusihi[rl} Cif fizf+,atsc!
<br /> Q. Lilt]Packs to he 'i'rcateri fly-lrlcincratinn (Ccr[I1ica[ion must lac caullrlcfcrl,) ��111„slr+li:. 1�.”T, '. .
<br /> I mains only a stalty of 131v that T btrl .pt:t•srjnally eltanutled and aril familiar will, il;o}1'r4sle uvtl
<br /> contains only wastes}� hicll Iravc licit beerl Gxr:lttded ulidL r Appellaix I�r fu 90 Cl'C;Part�f.q or solid`� tlts`
<br /> to regulation under 40 CPR Part 261. ] till,aware that there aro sib*mill..-fu lteCF irs t-r (flat the lab pac€c
<br /> including the possibility nCfige err itrrprisralr[neut_ aste,n:,(s0ject
<br /> r sunrr.tilting a false e_er,,ifcation,
<br /> 5. AI?pcndfx V La1j x'ack.
<br /> I certify under penalty of Iaty that J perstana[ly have exan�itled anti art,f-;trtliliar 1 €r[r flit, t, ,
<br /> tllxougl,Iatowlcdge a tyre waste at,d (!lilt file Jab park crlrllains aryl or,
<br /> or solid wastes not strisject to regulation tludcz I'ar-t 7_6I, I art,a}l are [Jtst tlrcte,ir,r sr s n, [c•tltrotig)r at[tjysis testing or
<br /> Y garlic l�'rrslc sjrtscMICd iu AI1Pcrtdix jr to part 268
<br /> false certification, inclurliag (Ile pussi[]ilit; n C filly or hIll]risoTrnrent,
<br /> grufir.ant pL atties Cor srAbrni(ting a
<br /> tttrc `
<br /> Print Name
<br /> Date
<br /> ti
<br /> 3 urs
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