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St-0,10cle Ell Virorrtrtetttal Soltdtfa}tS <br /> RCRA Larrd Dispnsaf.Restriction Natocatfor:l•ortn <br /> Generator: Work Order # <br /> US EPA ID <br /> No. <br /> PSC Profile _ <br /> No. L co Manifest <br /> In acco"dance -a,fth 40 CFR 268.?a, <br /> (J the 7uadet lytn hazcrr rlasrs constit"ents mast be addressed in this Ivaste Pet <br /> 268.2(o, "uncder lying liar ai waits can rtitaient"means any constituent listed in 268 48 Table UTS--Univer sal Treatment <br /> Stfldar d svkiolz can reasonably be erpected to be pr eser�t at the oirat o <br /> code(s),ratop above the CpnStiti[St7t,5F72C C UTS treatMunt standard. Refer to.Form—,z (anached or t17e <br /> P f generatfon of the hazardot►s waste, at a <br /> code(s), tr ecatabilitygr•oup, and subcategory applicable to this waste. <br /> f waste <br /> In order to add Vss tinder lying hasardou,7 constitrcents in char•acte•istfcwestes,please check the appropriate opriate bo - <br /> M I have reviewed the UTS list of 268.48, and per 268.7(a),I have determsned that ther <br /> Underlying hazardous constituents.reasonably expected to be present in this waste, a are no <br /> Al have reviewed the UTS list of 268.48,and per 268.7(a),I have determined that and <br /> hazardous constituents are present in this waste. The underlying underlying <br /> identified as follows: yang haaardous constituents are <br /> ------------ <br /> The deter tnt'iratfon of Underlyfng ha ardoars Was bused ars; <br /> Cxl Generator's knowledge of the waste <br /> d Analysis <br /> I certify that I personally have examined and am familiar with the waste through analysis,and <br /> lctotiv3edge of the waste to support this eertificatan.I certify that as an authorized representative of <br /> names€above,.all the information subuaitted In. t'O .1 cecafy t is true and correct Y testing,or through <br /> the generator <br /> to the best of my knowledge. <br /> Printed.Name 3 .3—zc, <br /> Signature Date <br /> Form EZ Revised(}7/31.19$ <br /> This is a two sided for <br />