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F. raf a- <br /> '� O <br /> Nr" <br /> O <br /> '--�- 'nHrrvn,— <br /> AUM <br /> An" <br /> MMrs onl rn� v n c rr <br /> � L � �rw. ' N <br /> '7R1 <br /> I MA a <br /> � r Irma <br /> ry <br /> Lf� <br /> OISt- <br /> 0- RCR4 Land Dhposal Restr/cton Not/licadonForm <br /> Work Order N <br /> US EPA I�OUS���nO — qj-9Jv-19—Q �-.Q oanlfestce with 4D CFR 168.7(a), the undelying hsodousconstitrents must he addressed in this waste. Per <br /> nderlybW hazardous oonsttient"means any constituent listed in 168.48,Table UTS—Gntasl Treatment <br /> Ehich cmr renaonably be uapected ro be present at the point ofgeneraton of the hazardous waste, at a <br /> n above the aonst}uenl-yp¢cific U7S treatment standard Refer to Form-EZ(attached)for the waste <br /> code(s).treatability group,and sabeategory applicable to this waste. <br /> N <br /> O <br /> Ir,order to address underb ing horardous constituent,in characteristic wastes,please check the approprlafe bas: <br /> C I have reviewed the UTS list of 268.48,and per 268.7(a),I have determined that there are no <br /> underlying hazardous constituents reasonably expected to be present in this waste. <br /> O <br /> C I have reviewed the LTS list of 268.48,and per 268.7(a),I have determined that underlying <br /> hazardous constituents are present in this waste.The underlying hazardous constituents are <br /> O identified as follows: <br /> 0- <br /> .U) <br /> cts <br /> -a <br /> N <br /> P <br /> .N <br /> ?'ne delermmation otundenying haaardous constituents was based on: <br /> C: Generator's knowledge of the waste <br /> 3 <br /> o Analysis <br /> N <br /> N <br /> I certify that I personally have examined and am familiar with the waste through analysis and testing,or throueh <br /> LL <br /> knowledge of the waste to suppon this certification.I certify that as an authorized representative of the generator <br /> ( named above,all the information submitted in this notification is true and correct to the best of my knowledge. <br /> i9 <br /> 00 <br /> Printed Name <br /> (D Signature Date <br /> i9 <br /> (D <br /> O <br /> CD <br /> LL Form EZ Revised 07/3iM <br /> m <br /> (� This is a two sided form <br /> ti <br /> 00 <br /> N <br /> i9 <br /> O <br /> C <br /> O <br /> ON ♦i Cf) <br /> N C: ,' LU75 . <br /> A <br /> A N <br /> 0 <br /> C/) A <br /> O � Q <br /> O N O <br /> O <br /> 07 \ �0 <br />