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Applicable Certifications PART Ill.Authorized Representative Crosby&Overton Profile Number Manifest and Line Item Number associated with waste shipment 112540 CHECKTHE APPROPRIATE CERTIFICATION 1.Generator's Certification(268.7(a)(2)(11))for waste that meets Treatment Standards 1 certify under penalty of law that I personally have examined and am familiar with the waste through analysis and testing or through knowledge of the waste to support this certification that the waste complies with the treatment standards specified in 40 CFR,Part 268 Subpart D and all applicable prohibitions set forth in 40 CFR 268.32 or RCRA Section 3004(d).I believe that the information I submitted is true,accurate and complete.I am aware that there are significant penalties for submitting a false certification,including the possibility of a fine and imprisonment. 2.waste Treated to Remove Characteristics(268.7(b)(5)(iv)) 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 characteristic.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 fine and imprisonment. 3.Debris Treated to meet Alternative Standards(268.7(d)(3)(fii)) I certify under penalty of law that the debris has been treated in accordance with the requirements of 40 CFR 268.45,f j am aware that there are significant penalties for making a false certification including the possibility of fine and imprisonment, _ 4.Lab Packs to be Treated by Incineration(Certification must be completed.)Appendix IV Lab Packs I certify under penalty of law that I have personally examined and am familiar with the waste and that the lab pack contains only wastes which have not been excluded under Appendix IV to 40 CFR Part 268 or solid wastes not subject i to regulation under 40 CFR Part 261.1 am aware that there are significant penalties for submitting a false certification, including the possibility of fine or imprisonment. i 5.Appendix V Lab Pack: [ j 1 certify under penalty of law that I personally have examined and am familiar with the waste through analysis testing or through knowledge of the waste and that the lab pack contains only organic waste specified in Appendix V to part 168 or solid wastes riot subject to regulation under Part 26 1.1 am aware that there are significant penalties for i submitting a false certification,including the possibility of fine or imprisonment. Signature Print Name Title pate 3of5