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3 <br /> Underlying Constituents to be Mi initored <br /> F <br /> F039(Constituents to ben nitored must be indicated.Use Form LDRN-1A) <br /> F001-F005,I)001(other thE n residues from RORGS or CMBST),D002,D012-DO43(Underlying constituents must be indicated. <br /> Use from LORN-1 A) i <br /> 0efined:An underlying constitue t includes any constituent listed in 268.48.Tabie UTS-Universa)Treatment Standards,except Zinc, <br /> which can reasonably be expecte I to be present at the point of generation of the hazardous waste a concentration above the <br /> constituent specific UTS treatmer L standard, <br /> The waste is a characteristic iazardous waste DOW or D002 which is intended for treatment/disposal in a CWA system, <br /> CINA-equivalent system,or Class I SDWA system.Underlying Hazardous Constituents(UHCs)are NOT required to be identified. <br /> The,,vaste is acharacteristic azardous waste D001 High TOC Ignitable Liquids Subcategory(i.e.,greater than or equal to 1 O%TOC). <br /> Pursuant to 40 CFI,258.40,the wi ste must be treated using organic recovery(RORGS)or combustion technology.UHC`s are NOT <br /> requires{to be identified, <br /> € <br /> Check here if the waste is a 012-17 non-wastewater or a 0018-43 that is intended to treated in a CWA system,CWA-equivalent <br /> system,w Class I SpWA system.If so,the waste is EXEMPT from the LDR regulations,and no further information is required. <br /> Deadline Extensions and Varianc s <br /> r' <br /> Certain wastes may be subject to i deadline extension or variance(e.g.treatability,variance,case-by-ease extension).Describe below <br /> any extension thaf.appiies to a wi ste in this waste shipment(include dates and waste codes). <br /> i <br /> NOTICE. <br /> This section must becompleted(at ach additional sheets if necessary) <br /> Basis for this certification.Describe he knowledge upon which the certification is made. Materials and processes knowledge at generator <br /> t <br /> ARETHERE ANY CCJNSTnENTS JVHICH DO NOT MEET APPLICABLE LDRTREATMENTSTANDARDS? <br /> If yes,please list the constituents w ich require further treatment. <br /> 011, <br /> F001 chlorodittuoromethane <br /> i I <br /> iF AJ CA 7 <br /> i <br /> l Signature Printed Name Date <br /> t <br /> 2of5 <br />