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Page 1 of 9 LAND DISPOSAL RESTRICTION NOTIFICATION FORM FOR WASTES SUBJECT TO THE TREATMENT STANDARDS FOUND IN 40 CFR 268 GENERATOR NAME MANIFEST NUMBER Pacific Southwest Container 011094645FLE Line SD Waste Approval# Ccde(s) Subcategory UHC'S NWW or WW Bona�cial 1 013771032312/ D002 NVW1, 070137710- 32312 122 Lrrre TSD ov Code(s)Waste rov Appal Subcategory UHCS NWW Speciai # or WW Conditions 2 0137710323121 0002 NWW, 070137710- 32312 122 SPECIAL CONDITIONS: A. Waste Requiring No Further Treatment B. Lab Pack Waste Qualifying for Alternative Treatment and 40 CFR 268.40 C. Hazardous Waste Debris subject to standard treatment requirements,40 CFR 268.40 D. Hazardous Waste Debris subject to aftemative standards in 40 CFR 268(list contaminants) E. Waste Qualifying for Exemption and not subject to Land Disposal Restriction(Explain) F. Characteristic waste that are subject to the treatment standards in 268.40(other than those expressed as a required method of treatment)that are reasonably expected to contain underlying hazardous constituents as defined in 268.2(1);are treated on-site to remove hazardous characteristic; and are sent off-site for treatment underlying hazardous constituents(list constituents) G. Characteristic wastes that contain underlying hazardous constituents as defined 268.2(1)that are treated on-site to remove the hazardous characteristic and the underlying hazardous constituents to levels in 268.48 Universal Treatment Standards. H. For Chemical Manufacturers,Petroleum Refineries,Coke By-Product Facilities and RCRA TSDF handling wastes subject to 40 CFR 61 subpar FF ONLY. This waste is"Controlled Benzene Waste"which is subject to the notification requirements of 40 CFR subpar",FF. I. Certification for contaminated soil indicating the presence.or absence of characteristic and/or listed hazardous wastes. J. Certification for contaminated soil treated in accordance with 40 CFR 268.49 Waste analysis is attached where available;otherwise the information contained herin is based upon my thorough knowledge of the waste(s). I hereby certify that I believe that the information I have submitted is true,accurate and complete. SIGNATURE TITLE DA E Qt4 L WASTE STREAMS IDENTIFIED BY SPECIAL CONDITION A I certify under penalty of law that I personally have examined and am familiarwith the waste through analysis and testing or through knowledge of the waste to support this certification that the waste complies with the treatment standards specified in 40 CFR part 268 subpart D and ail applicable prohibitions set forth in 40 CFR 268.32 or RCRA section 3004(d). I believe that the information I have submitted is true,accurate and complete. I am aware that there are significant penalties for submitting a false certification,including the possibility of fine and imprisonment. WASTE STREAMS IDENTIFIED BY SPECIAL CONDITION B I certify under penalty of law that I personally have examined and am familiar with the waste and that lab pack contains only wastes which have not been excluded under appendix iv to 40 CFR 268. lam aware that there are significant penalties for submitting a false certification,including fine and imprisonment WASTE STREAMS IDENTIFIED BY SPECIAL CONDITION F I certify under penalty of law that the waste has been treated in accordance with the requirements of 40 CFR 286.40 to remove the hazardous characteristic. This decharacterized waste contains underlying hazardous constituents that require further treatment to meet universal treatment standards. I am aware that there are signficant penalties for submitting a false certification,including the possibility of fine and imprisonment. WASTE STREAMS IDENTIFIED BY SPECIAL CONDITION G I certify under penalty of law that the waste has been treated in accordance with the requirements of 40 CFR 286.40 to remove the hazardous characteristic,and that the underlying hazardous constituents,as defined in 268.2 have been treated on site to the 268.48 Universal Treatment Stardard< I am aware that there are significant penalties for submitting a false certification,including the possibility of fine and imprisonment. WASTE STREAMS IDENTIFIED BY SPECIAL CONDITION I I certify under penalty of law that 1 personally have examined this contaminated soil and it[DOES/DOES NOT]contain listed hazardous waste and [DOES/DOES NOTj exhibit a characteristic of hazardous waste and requires treatment to meet the soil treatment standards as provided by 268.49(c). WASTE STREAMS IDENTIFIED BY SPECIAL CONDITION J I certify under penalty of law that I have personally examined and am familiarwith the treatment technology and operation of the treatrnent process csec to support this certification and believe that it has been maintained and operated property so as to comply with treatment standards specified in 40 CF.R 268.49 without impermissible dilution of the prohibited wastes. I am aware there are significant penalties for submitting a false cartification.including the possibility of fine and imprisonment. nyr { (7l f NOV 0 3-2017 ""ORIGINAL SIGNATURE PAGE TO ACCOMPANY MANIFE-'EWIRONMENTAL HEALTH RAF�TMENT -__....._ _ ___