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US ECOLOGYnMYA—S ECOLOGISTS LAND DISPOSAL RESTRICTION FORM WASTE GENERATOR: NUIufBER EPA LD.NLiMBER: ••-:�.As4.ti J � qy WASTE IS: NON•WASTEWATER WAR NUMBER:ockpm)Sh Pty) EPA HAZARDOUS WASTE CODE(S) S ORY (IP NOT APPLICABLE,ENTER"Nl/Aj (IF ADDITIONAL SPACE 1S REQUIRED PLEASE ATTACH ADDITIONAL SHEETS.) A.[ ]RESTRICTM WASTE MEETS TRxs nt,mNr eT.,a...RDS The rpaieaed wasps id—tiacd res (oro CFR 1t 268 X2}) _ above tttay me tsrt�stanidxads in 40 CPR 268.41 and/or 268.43 pmlabidaa levels 3a whore��(d)and can be land 41sposrd fan without ha tr oetatg 4 I have attached all mVpanalytical data, I*mTUy under Penalty of law that I paumally have amlifted and am familiar with the waste through analysis and testing or dumgh knowledge of the wane to support this eaCficalion that the was complies with the 26852 armied in 40 CFR Pan 268 Subpert D orad all applicable ptoht'iutiorm sex forth is 40 CFR bmammm standards 3004(4 Ibelieve that the information I mbextiaed is true,awarate and casmpiem I am aware than oto significmt penalties for sabtmbmg a false c mficawt4 including the pout'bility of a fine and imprisomacuL B.( I 1�=STANDARDS (40 CFR 26&7(bX5)(1)) The treamyem residue Or user of such fasidue,of the rewsoccted waste identified above has been tested to assnye that the b7ra=enx residua or calrsm meet the appiiahle treaCacat standards or P[nhbidons m 40 CFR 268.41 andlm 268.43. I have attached all suppeetittg matytiCal data,wbao available. I certify undo penalty of law that Ib"pmacnilly esatmined and mm fmmiliar with the tteatmtat to tutology and operation of the trratmtnt proem used to support this eatificanon and that,based cc my inquiry of those nrdrvtdttals rmponsiblis for obtaining this bdamad=I believe that the treatment proom has bmm operated and maintained properly so as to comply with the pedes levels specified in 40 CFR Part 7.68 Sub- part D and all applicable ptobib2tions set forth in.40 CFR 268.32 or RCRA Section 3004(d)without impmnisstbie ddu4M of the prob9med waste I am avms that thaw are sigaf5eam penalties for suhmgCirrg a falx osmification. inehrdng the Possibility of fine or wgximmsenc G ( � WASTEWITH RFZrP'CTED (40 CFR 26&7 (bX5)(n�} I '»s 'Pena1ty of Ww-that ibe IF&M has been aeaced in accordance with the requirements of 40 CFR _ - 26&42 I am aware that tbae we sigmfieent penalties formtb=mwg a false certification,includatg the 20th of a fine and imprixa�L Pmt ty Q K RFS'IRICl'ED WASTE S[ SIECT TO VARIANCE OR oCtENSION(40 CFR 268.7(a)(3)) The resmamd waste identified above is sttbjax to a caxbyuse Mansion tinder 40 CFR 26&5,an asempaon under 40 CFR 268.6,or a Naaonwido Va6a nce uttdcr SWVsrr C of 4O CFR 268,and is not pto{abited from land disposal The corresponding aatrntat sta nda-da(s)or Probibidons are promulgated is 40 CFR 268.41 and/or 268.43. I have attached all supporting analytical data.where available. This wase betmmm subject to the Land Disposal Prohibitions on S / `1 Z E( 1 RESTRICTED WASTE SUVECI TO TREATMENT(40 CFR 26&7(aXl)) (DATE) The poor-w:akwata renneted wase idea¢fed above n>st be wmad to the applicable trot standards promulpred m 40 CFR 26&41 andim 268.43,or treated to comply with applicable prohibitions set forth in Part 268.32 or RCRA Section 3004(d)- I carfy and warrant that the mfamanon chat appears on this fdat and my appended down.is true and cortxL I have correctly utdicaLed know my waste is to be managed in accordance with 40 CFR 268. My certificacon is based on personal examination of the information submitted,or is thawd on trry mquieic of those individuals responsible for obtaining the information. Authorized Si ` Td & !+.f(/fY ientai /9 7ta�iie s(zen b00 ' 39tld DNI -040SNJrb3 NOrlj zr:at E6 . 9 NHr