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Slericl'cle Fravirotrrtaerrtrr!SOltfti4l7s <br /> 9CRA Land Disposal.?eSlFlCliOtt NQtifrcr7tIOII FOPtIr <br /> Worst order n <br /> Generator: <br /> US EPA IID <br /> No. Clem <br /> PSC Profle <br /> No. Planifest <br /> Ivo. <br /> 117 accordartce "Pith 10 CFR 268.;(al t17e rrt�derlrina <br /> X 68?(�). "rnrder lj,irjg hcrsar cfous corrstitrrerrt"»)eaj2S a i;Ica st �e 7f lrlfs attecl i17 268 ts 1 8 Ibe Toble UTSs- Cjjin <br /> vers rl waste. <br /> Per <br /> Standard i<<Jrich carr reasor7abli be etpecled to be presery at N7e oirrr <br /> fnrer7t <br /> Cortcer7tratior7 above the cor7stitrrer7t-specific UTS d eatmenr staradcrrc�! Refer to Form-EZ Po';?' o ger7erafiorr of the hazardous js asfe, at a <br /> codes/, r-ealability group, ar7d subcategort:applicable to this r s,asfe. (�ttaclted <br /> �for tl7e waste <br /> In order to address trt7der-Il if7g l7aardous constitrrer7ts irr characteristic Wastes,please clreclti the appropriate box: <br /> ❑ I have reviewed the UTS Iist of 2 <br /> ve determi <br /> underlying hazardous constituents easo able expecteer d to beg present in Ined that there are no <br /> P this waste. <br /> I have reviewed the UTS Iist of25S.�S, and per 268.7(a). z have hazardous constingr <br /> ituents are present in ti-tiswaste. The underlying hazardousdconst tt elthat ets are <br /> Identified as I'ollotivs: <br /> The de1e1•111ir7ati0r7 of wader ljling hazardous c0r7stituerats was based 017: <br /> O Generator's know-ledse of the ;-N aste <br /> El AnaIvsis <br /> I cerci <br /> f} that I personally have examined and am familiar with the waste through analysis and tesrin! or through <br /> named <br /> ledge oft all <br /> waste co support this certification. !certiA,that as an authorized representative of the generator <br /> Wanted above,ai]the information submitted in this notification is true and correct to the best of env knowledge. <br /> Printed ? ` <br /> Signature Date <br /> orm EZ Revised 07/31/98 <br /> This is a nvo sided form <br />