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061 ? LAND DISPOSAL NOI ATION AND CERTIFICATION FORM PHA; / Paye i of 1 Generator Name: Shell Oil Products US EPA ID,r:_Ca2000l J 1 H State Manifest No. ��1523b — 1.If waste is a waste water(see 40CFP 268.2_)place"w"next to the applicable code(s) Pro file# � CODES WITH SUB CATEGORIES(place appropriate letter from section 8 before each code that applies)(See 40 CFR 268 for details) DO01 HI-TOC DOGS Lead Acid batteries 1(069 Not Calcium Sulfate P065 Lo RMERC Res. _ U151 Hi Hg DCC'. Except HI-TOC D009 Organic Hg>260 opm )(071 Rmerc Res. __PC65 Not IncJRMERC Res. U240 2.4 0 D003' Reactive Cyanide D009 Inorg,Hg>2SOppm K071 Not Rmerc Res. _ PC65 Hi Inc./RMERC Res. U240 2,4 esters 8 Salts D003 Reactive Sulfide _ 0009 Hg<260 K1 06 Lo Rmerc Res, _ P092 Lo Ina Res. DOC3 Exolesive F025 Light ends 1(106 Not Rmerc Res. P092 Lo P.MERC Res. 0003 Water Reactives F025 Spent filter KIDS >260 ppm Hg P092 Not Inc,/RMERC Res. D003 Unexp brd.Emg KOOG Hydrated P047 Sells P092 Hi IncJRMERC Res. DCC3 Other Reactives K006 Anhydrous _ P047 Nonsalls U151 Lo RMERC Res. DOC6 Battenes 1<069 Calcium Sulfate _PC65 Lo Inc.Res. U151 Lo Not RMERC Res. The subcategory for D018-D043 waste Is"treated in nonCWA/nonSDWA facility'unless the following box is checked: E lreaccf in CWAiSOWA facility" 3.COMMON CODES(Place appropriate letter from section 8 before each code that applies) D002 P012 P030 P051 _P098 P105 P205 F006 _ F007 F008 F009 _ FO10 F011 _ F012 _F019 FC39 D020 D005 DDCfi D007 DODS __ 0009 D010 DOI1 0012 D013 D014 D015 D016 D017 _ Dole 0019 D036 D021 0027. _._D023 D024 D025 0026 D027 D028 D029 DG30 D031 D032 D033 0034 D035 UC07 D037 D038 0039 D040 D041 0042 D043 FOOT F002 F003 Fool F005 0002 _ UD03 0005 _- UCCi U044 U061 U072 LOBO U108 ._, U117 U122 — U123 U136 U154 U188 U213 U220 U226 _ U279 ADDITIONAL CODES(Enter all codes not identified above which are associated with waste) KC61 4.USEPA HAZARDOUS WASTE 5.TREATMENT STANDARDS FOR NON-PHASE II STATES(INDICATE THE APPLICABLE 6.HOW MUST THE WASTE BE CODE(S) TREATMENT STANDARD 268.41,2.65.43 OR SPECIFIED TECHNOLOGY BELOW MANAGED?ENTER THE LETT ER FROM BELOW D001 D018 — - - -- - -- - — — — -- --- - A To identify F039 or UHCs manage In non-CWA,use the"F039/Underlying Hazardous Constituents Form"provided and check here: ❑ If no UHCs are present upon generation check here:0 Checl(here if disposal facility will chert(for all UHCs ❑ (Le no UHC form required) To list additional EPA waste code(s),use the supplemental sheet and check here: ❑ In lieu of supplemental sheet you may use multiple copies of!his form. 7.SOLVENTS CONSTITUENTS(F001-F005)Check here if disposal facility will check for all spent solvents Acetone Benzene n-Butyl alcohol Carbon disulfide Carbon Tetrachloride Chlorobenzene _0-CresolCyclCresols(mGp) Ethyl benzene o-Dichlorobenzene _ 2-Elhoxyelhanol Ethyl acetate Ethyl benzene Ethyl ether _ isobutanol Methanol Methylene chloride Methyl ethyl ketone Methyl isobutyl ketone Nitrobenzene 2-Nilropropane Pyridine Tetrachloroethylene Toluene 1,1,1-Trichloroethane 1,1,2-Trichloroethane 1,1,2-Trlchloro,1,2,2-trifluoroethane Trichloroethylene Trichloromonofluoromethane Xylenes -- 8 (States authorized by EPA to manage the LDR program may have regulatory citations different from the 40 CFR citations listed below.Where these regulatory citations differ, your certification will be deemed to refer to those state citations instead of the 40 CFR citations.) A.o RESTRICTED WASTE REQUIRES TREATMENT This waste must be treated to the applicable lrealment standards set forth in 40 CFR Part 268.40 ❑ For Hazardous Debris:"This hazardous debris is subject to the alternative lreatmenl standards of 40 CFR 268.45." B.1 RESTRICTED WASTE TREATMENT TO PERFORMANCE STANDARDS "I certify under penalty of law that I have personally examined and am familiar with the treatment technology and operation of the treatment process used to support this certification. Based on my inquiry of those individuals Immediately responsible for obtaining this Information,I believe that the treatment process has been operated and maintained properly so as to comply with the treatment standards specified in 40 CFR 268.40 without impermissible dilution of the prohibited waste.I am aware that there are significant penalties for submitting a false certification including the possibility of a fine and B.2 (CERTIFICATION REMOVED BY PHASE IV) B.3 GOOD FAITH AND ANALYTICAL CERTIFICATION• FOR INCINERATED ORGANICS "I certify under penally of law that I have personally examined and am familiar with the treatment technology and operation of the treatment process used to support this certification. Based on my inquiry of those individuals immediately responsible for obtaining this information,I believe that the nonwastewater organic constituents has been treated by combustion units as specified in 268.42.Table 1.1 have been unable to detect the nonwastewater organic constituents,despite having used best good faith efforts to analyze for such constituents.I am aware that there are significant penalties for submitting a false 8.4 DECHARACTERJZED WASTE REQUIRES TREATMENT FOR UNDERLYING HAZARDOUS CONSTITUENTS "I certify under penalty of law that the waste has been treated in accordance with the requirements of 40 CFR 268.40 to remove the hazardous characteristics.This decharacterized waste contains underlying hazardous constituents that require further treatment to meet universal treatment standards.I am aware that there are significant penalties for submitting a false certification including the possibility of a fine and impdsonmenL" C. RESTRICTED WASTE SUBJECT TO A VARIANCE This waste is subject to a national capacity variance,a trealabitity variance,or a case-by-rase extension.Enter the effective date of prohibition in column 5 above. M For Hazardous Debris:"This hazardous debris is subject to the allemallve treatment standards of 40 CFR 268.45." D. P,ESTRICTED WASTE CAN BE LAND DISPOSE WITHOUT FURTHER TREATMENT "I certify under penally of law that I have personally eramined and am famlllar with the waste through analysis and tesfing or through knowledge of the waste to support this cenlficalion that the waste complies with the treatment standards specified in 40 CFR Part 2G8 Subpart D.I befieve that the information Isubmitted is true,accurate and complete,1 am aware that there are significant penalties for submitting a false certification,including the possibility of a fine and imprisonment." E. WASTE NOT CURRENTLY SUBJECT TO PART 268 RESTP.ICTIONS This waste is a newly identified waste the :s not currently subject to any 40 CFP,Pan 268 restrictions. I hereby certify that all infom:a@on in this and all ass gated Yc5ments is complete and accurate,to the best of my knowledge and information. Signature Title -`-- - :-- - c�poration ?: _ah pie ael-v'e_= Date FORM t OES-780 GENERATOR COPY