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AppllCabl,, Ce (iIiC;1tZ(JII�;
<br /> iT 17I, Authorized IZe err-scn(ative -
<br /> f1yXc Ovcrinn flnf11cTda bur
<br /> 'Munifcsl rind L'rrsc N;nl TIUr;Ib.f'i1FAl•ci;llc-'.V.101.lvnsta slli[Il:rtni
<br /> 51192 & 51169, 51195 23758545. 11 :b y& d, & c
<br /> HECK THE A-FPROpRV:T1✓ C:LRTI>+fCA 1-10N
<br /> 1. Generator's CerUfir_:1tIon (268.7(;,)(2)(11)1 fortti;ste t]1rtL rutt:is'freatrnertt Sl,tn.i s[t!c
<br /> f cer[ify under penalty of law flint Ipctst]nelly have exanlistt"ti r+u(1-atit
<br /> and testing or tfa[icifitcwi(� lei v:[5(c (luciuils auafysia
<br /> ltrout h Isnaw[cdgc of I,Li.wade fa ssip)]ori I[lis Lc:ififlt'.^,i[un Ilt,tt fJlc tt lstc Lt i1lPlic,s tvi[(t [lrc frcaLtltrrlt
<br /> standards specified in 40 CFJI , Par(26-8 S1th1)a>t D and au aI7[]3icablc Lc fiurCtl iu 10 GI'R 2[.iF.:s2 a;RC'kr�
<br /> Section30D4(d), 1 i�clicve tltat.l]te ifir.or[�ri:Ilion 1 SLibini[(ed is I,ur., tccura[4 arid Cr)tltltiic.tc, t tlt7 awart ilia[lllers nre
<br /> Significant penalties for subrrd"IL; a fal.rr, rcr'6f1c:a(i0'n, incltldiub (110. I)ossibili(y 011, finr; irwrl itnprisousru nt.
<br /> �2. Waste imateci io Iter,toVe (:,inrar.ttrl.slit.s
<br /> I certify tzndeirpenafty of(aAv tba[ Lbc�vas[e lues heel {tc t(e.r1 iii nCCtAdRL•L•e tvfLfI tl:r,re..tllrirclne,its nf'd(1 C;I IZ �f 8.4f) to
<br /> remove ilia hazardnus characteristic. T,is tita,haraclNtizetl wa.Ste cundaitls ulslcrlyin 1,a�l,,drJns CU11sfl[[lefli5 768
<br /> regii rc.further ireatrltent to ,,cc t111i�rrsat h-"t7lleu(s[arldar�k. I r,n1 a�.aru ilia( i[rclr:;[.•,yjg[rltiL9lI I)Pnallres for
<br /> lia
<br /> submitting a false ccrLificat]oll illcludirtg We Ile ssibility of fine fl;)d ival)1.,,5nutetrl.
<br /> _3. DeI7ris Treated to Moe f.Alterrlaf']vc St,ir111:trtls(2G8.7{,l)(�){lei)).
<br /> I ccllify trr,tler 1jL;r1U1(y aflaty titnt tlio ticf-t�s"$ b,xn tir,a[Cd in r:curclzltcc ureter[01c; r�'}t:fil:i�Ec,;[s uftl[] ClR%68.15, j
<br /> am aware Chat Werc are sigrlificalt[ n
<br /> Ilena]tius fcu'111,0drig a false cer[iCcalcuLE tacludir.1g [-[ iltl;sillifit}' of(ilii, u]t1
<br /> imrrlp ri s o]tn]ott t. -
<br /> 4. Lab Pricks to be Treafed byIncinera(fn:t (Cei-M3catiun must,I)e encu ;tctcd, .
<br /> I certify under pedal ty of la%v that 11]:sve. r.rsrsnal ! ) �1l,pel:tli; 14 1.nft I'tcks
<br /> conidins only wastes x'1Llr,.jt llaVC'73fl-
<br /> 0(lrcelPex(:luded Li ldt7r p Cild 1 nl�a(U1r4t0 (f'tar l]f(go IvEl""r ud (Is wU?[.I; b l( c ,
<br /> to reguf2tio7] undcr40 CFR!'art 261, T run aware Lhat Were ase sib>ni-V tn( ;e[=F jcs fr. Z.lec(
<br /> including the passiliilityf prflItC or i711tJlIsol1ri1Zr11., L Su[•11LLhUng a 1atse C-ect.ifcatiatt,
<br /> 5. Appendix V Lub Tack:
<br /> 1 caug1-l'underpenaIty oflaw Ilia[} personail} leave cxanjlned al,cl.[u[r ftrtliliar V'-'l 1) flee ittrulrgfi u1i t[ysis [esLin� or
<br /> t[uoughic]towlcdge oltl[e waste earl Thai lite lab prink,corttair-is only nrgartic u'asic ..d iu,4 1 entltx�r to
<br /> or solid wastes not subject to regulu 6011 uucicz Trart 761• I a;il aft�e.Llrat ilu'i e ire srgni(zrant l�Appces Cc�r sv[lt[tirt 26 a
<br /> 1 l: part 2C��
<br /> false cet-Cification, includirig tire passi[rili{y nCtittc or jtn[lrsst?nnlel[t.
<br /> L T
<br /> Pi•in[ 14altte,��
<br /> Date f
<br /> J of 5
<br /> E
<br /> 1
<br />
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