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- •--- a VVI'JLL-Obbb 1-4.74 POQ12/0012 F-956 <br /> • <br /> C�rvEc <br /> AZI�IXieable Cet tAf"Icaf�ons APR 0 8 2015 <br /> PART In. Authorize Ice resentative ENTAL <br /> GWaby&Orcrton Profdn Number <br /> Manitu3 and Cin.lwmNumber aeroe(e(cd wlth%v"(.abt aA',—Y T"D OT1pChff <br /> F <br /> ROPRYATE CBRTMICATION <br /> ar'a (268.7(a)(2)(tq)Yorwaetethatmectsunder panai(y of taw that I patao>a)ty haus examined and am fanrilier with the tvaata through analy¢Is <br /> ng or through lotoWlodgo of the waste to aupporithis certificationihntthe waste eompliav WIOt cite healmorlt <br /> s specified In 40 CER,Part268 Subpartn andallapplics004(d). I 6eltcvb tlwttheinfolrnationil ubitd is true,accurate andcompleto. I emawaretbatthere arc <br /> gntpenaltiea for subrtdtting a false cerlification,including the p098161(ity ofa£mo and impdsonmenE <br /> 2.Waste Treated to I2errtova Cftaraetdrlstfca(268.7(b)(6)(iv)) <br /> I certify undorpeaalty of law thatthe waste has been Heated in accordunce vrith the rcclPhaaieuts of40 CB1Z268.40 to <br /> romov6t4t;k ardouschameteristic, This deohawote&odwas teconfainswtJerlyinghaamdouseonetituentcflat <br /> iequire5u4drtleatmcnttomeetuvivetaolereatwantataadards, Iemawarothat kere,aye; <br /> stgnifioantpennitiasbr <br /> submitting a Iblse certification including the posdbfpb,offinc gad impriconment, <br /> ^3,Da'6rIslYeated fo tnaetAltcrnativatitandards(26&7((1)(3)(111)) <br /> Iooraft underpenaltyoflawthatthedobrisfiasbeentreatedinnaaordancetdtht6requicementsof40CPR268A5. 1 <br /> arnaworothatthere are significantpenelflea for making aAlsa cettiftcation including theposslblllty of llna sad <br /> kapdsonnleaC • <br /> 4.Lab Packs to bo Treated bylnciueratlon(Certification,must be completed.)Appendix IV Lab Packs <br /> Icer*underpenalty of low thatS have pemonally 6X241140(1 andamfumillarwlth the waste and that the labpaok <br /> C contains only wastes which havenot been excludod under Appondixlvio 40 CPR part 268 or solid wastes notsubjcet <br /> to regulation under40 CPRPart 26l'. I stn aware lbatthato are sigeiftcantpena%m for submittinga false eerti6cation, <br /> Including the possibility offine or3mprisoarnenk <br /> S.Appendlr.V I.ab Pack: <br /> IcerH{yuttdsYpongityoflgwtha[TpersoaallyhoveexemLtsdandamfamlliaztvititthowaBfet6muSk�giYslsteslinger ) <br /> 0lraughlzrowledgeoflbswasteandthatthelabpacSconta)asonlyorgapiewastespeciftad nAppeadlr.Vtopart 262 <br /> or solid wasfas notaubjeotto regulation underPattldl. I am aware that there are aignillcaatpeaaltiss forsubidging a <br /> false codification,including the possibility of fine or ivVilvonatont <br /> Signature / PrIuManae /� � <br /> ` 01f e <br /> Date !A <br /> TI(Io .Pit -�r •211.¢ r- ��"[''l�~ <br /> 3 af3 <br />