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W l es cnv i fonmenLa l lib l—�L'L—b?StSJ <br /> S 1-4b4 f UM1007 2 F-956 <br /> iI CEIVEr� <br /> Applicable Celr( icatious <br /> APR 08 2015 <br /> PAI2TITT. AutnarJzedl;e resenfative _ <br /> C5t1[bY&Ovrtton PrortIoNuMbar ur <br /> 1RE �� <br /> Wnir=odLine lmmwum6er aesodekdvAlh��i�o�s1itphfehrod pT /,raj <br /> Cf111 CM13APPR.UPPIATJ3CBitT 4CAMN <br /> % 1. Generafor'a CerltZlogfiott(268.7(a)(2)(fq)for waste that meets xreatmentStandarde <br /> 10ettlfyunder ponally oflaW ihatSpataonal(yhave oramfued and em famfllor with tha waste through aualyc)s <br /> atrrl tosting ar througft lmoWlodge of tha Waite to aupporl this cectikcaO0n lhatthe-waste complfas Wldl do traabrtant <br /> sran4erdaspecitiediggOCBR Part 268Hubpld Id allappllcablaprohibll3onsseetbrthfngOCPR.26&32orRCRA <br /> Serdion�004(d). I bel{eyethmttheinfoauofionTsubmittediatrue,accuta(oaad-complete, Sam awarelNattharaarc <br /> sigoiflcant penalties forsubmltdrig a falso cerlfflradoty iucluding the posaibll(ty ora fine and imprlsonmont, <br /> 149610 Treated to Sernove CharaoferisGcs(268,7(6)(5)(iv)) <br /> I certify tmderpeaolty oflaw thatthe wast.has been mated in accordance with llta requirements of90 CFA268.40 io <br /> tomovd the bavatdous cbarecterlade, This deohatectetiYod waste eoa(afas underlying hazardous aonetituentc that <br /> regtrefiuthartYogtmeattomastugiyorealtreatmeptstendatds, 'am aware that tharaetosigaifinaotpanaIfiecfor <br /> aubmittinga else oo�eafi=includtgy the puss,'bility opf7au sud impriconmcnt <br /> �3, bebrlslYeated to maatAlteraafive5tattdarde(2G8.7(d)(u�(fii)) <br /> XoettltVuaderp0nal(yaflawtltatibedabttalwsbaenmated <br /> aemcaactcoiredaafnacnavjrli0tj[urdduingxcthueipoaclbJUotyf40CNR268.45, Iomawaretbattherearomoffinemd <br /> itnprieonnrent . <br /> _4.Lab Packs to ba Treated bySaclaeraffon(Cerfi>loaffoo mustba completed)AppcndlxTVS ab Pncke <br /> lcertify underpenslty of law chat dbavc panonaliy es wtnted andamfamiUar with the waste and that the labpack <br /> ( c0ataias only wastes whigir bavonotbeen exofudaduadarAppnndi>;IV to 40 CPT(,kart268 oraolid wastes not aubjeet <br /> to zegulatfon undor-40 CFXPart 2dl'. I Pm aware tbatthary are siOrmhntpoaaldes for submittinga6lse certgoafion, <br /> including the posaibiffty of fans orimprisoamenl: <br /> 5,AppondixVUbhoks ' <br /> I aerdfyunderpOnal(y oflaw thatTperaonal(yhaveexatnhtad otadamfamlliarwitltdte Waste tEuouglf aaaUsia fasttrt);or <br /> thraughknowledgg of lite wasra and that the lab pacbcontaim only orgatrio wSato specfffcd in AppeadixV to part 268 <br /> or solidwastasaotaubjeaftoreguladonugderFartZ6i, Saraawarethati4eroareaigniAaaatpanaltiaeforsubmittinnga <br /> falsa Cozacatfon,paclttdtag the possibility of fbae or irupzisonwnt. <br /> Signature krintNmme <br /> VIC <br /> =))ate <br /> 3 cis <br /> 1 <br />