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Sep 04 09 03: 10p L1.ndsa9 Schwager 2099523389 p . 10 <br /> Land Disposal Notification and Certification Form (Cont.) <br /> Constituents of Concern (For F001 - F005 EPA Waste Codes Only) <br /> 9b.1/W2/9b.3/9b.4 Constituent 9b.1/9b.21 9b.3/9b.4 Constituent 911 9b.2/9b.3/9b.4 Constituent <br /> Acetone ____Cyclohexanone ____ Nitrobenzene <br /> Benzene ____o-Dichlorobenzene ____ Pyridine <br /> n-Butyl Alcohol _Ethyl Acetate _____Tetrachloroethylene <br /> _ Carbon Tetrachloride ____Ethyl Benzene ____Toluene <br /> _ Carbon Disulfide ____Ethyl Ether ____ 1,1,1-Trichloroethane <br /> Chlombenzene ___ lmbW Alcohol ___ 1,1,2-Trichlomethane <br /> Cresol Mixed Isomers ____Methanol ___ 1,1,2-Trchloro-1,2,2-Tnfiuoroethwe <br /> Cresol,p-isomers ____Methylene Chloride ____Trichloroethylene <br /> Cresol,m-isomers ____Methyl Ethyl Ketone ____Trichloromonofluoromethane <br /> o-Cresol ____Methyl lsobutyl Ketone ___Xylenes(Total) <br /> Underlying Waste Constituents for Characteristics Wastes <br /> (From 40 CFR 268.48, not applicable for Lab Packs) <br /> 9b.1 <br /> 9b.2 <br /> 9b.3 <br /> 9b.4 <br /> Certifications <br /> 9b.1 9b.2 9b.3 9b.4 Waste Does Not Meet Applicable Treatment Standards <br /> �� ❑ ❑ ❑ Waste does not meet applicable treatment standards in 40 CFR 268.40 or exceeds applicable prohibition <br /> levels of 40 CFR 268.32 or RCRA Section 3004(d). <br /> Waste or Contaminated Soil Meets Treatment Standard At Original Point of Generation <br /> I certify under penalty of law that I personally have examined and am familiar with the waste through <br /> ❑ analysis and testing or through knowledge of the waste to support this certification that the waste complies <br /> ❑ E:1 ❑ <br /> with the treatment standards specified in 40 CFR part 268 subpart D and in CCR, Title 22, Division 4.5, <br /> Chapter 18, Article 4. 1 believe that the information I submitted is true, accurate, and complete. I am <br /> aware that there are significant penalties for submitting a false certification, including the possibility of a <br /> fine and imprisonment. <br /> Contaminated Soils Certification (Mark appriopriate answers in certification statement.) <br /> I certify under penalty of law that I personally have examined this Contaminated soil and it[DOES I DOES <br /> ❑ ❑ ❑ ❑ NOT]Contain listed hazardous waste and[DOES/DOES NOT]exhibit a characteristic of hazardous waste <br /> and requires treatment to meet the soil treatment standards as provided by 40 CFR 268.49(c)and CCR <br /> Title 22§66268.49(c). <br /> Lab Pack Alternate Treatment Standard Certification <br /> I certify under penalty of law that I personally have examined and am familiar with the waste and the lab <br /> ❑ ❑ ❑ ❑ pack contains only wastes that have not been excluded under appendix IV to 40 CFR part 268 and that <br /> this lab pack will be sent to a combustion facility in compliance with the alternative treatment standards for <br /> lab packs at 40 CFR 268.42(c). I am aware that there are significant penalties for submitting a false <br /> certification, including the possibility of fine or imprisonment. <br /> I hereby certify that all(information supplied is complete and accurate to the best of my tknowlledge an(d� information. <br /> vt <br /> Signat he: } �� Printed Name:l��l As`oj �lGnM15 4? <br /> Title: Q (.� { Date: �' p�- Qq <br />