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Y US Ecolofzv,Inc.Land Disposal Restriction Form Generator: Universal S®Mca Recycling Inc EPA ID Number: CAL000366717 Waste Stream or Profile Number: Manifest Doc.No. __ Line No. Waste is a: ❑ wastewater(<i%TSS and TOC) ® Non-wastewater ® Debris Notification Frequency, ® One Time ❑ Required with Each Shipment Shipment EPA waste Codes(froth 40 CFR 268.40) PM UHC's(Underlying Hazardous Constituents 40 CFR 268.48)? ❑ Yes 0 No If yes,list: Does a subcategory apply per 40 CFA 26SA0? 13Yes 0 No If yes,list: _ Constituents requiring treatment in F001.5,F039,debris,and alternate solls? ❑ Yes No Ifyes,list: ® See Prsfile for analysis(if any). A, ❑ Restricted waste Meets Treatment Standards(40 CFR 268.7(a)(3)) The restricted waste Identified above meets the treatment standards in 40 CFR 268.40 or Alternative LDR treatment standards for contaminated soil 40 Crfi268,49 and can be landfill disposed without further treatment. if applicable,under 268.44,this contaminated soil❑does or❑does not contain listed hazardous wasteand❑does or rl docs not exhibk a characteristic of hazardous waste and complies with the soil treatment standards as provided by 268.49(c)or the universal treatment standards. I certify under penalty of law that i personally have examined and am familiar with the waste through analysis and tasting or through knowledge of the waste to support this that the waste complies with the treatment standards specified in 40 CPR Part ZU Subpart D.I believe that the Information i submitted Is true,accurate and complete.I am aware that thane are slgntM1cant penattles For submitting a false cerdtt+.-attan,including the possibility of a fine and Imprisonmertt. 8, ❑ Restricted Waste Treated To Treatment Standards 140 CFR 268.7(b)(1)6 268,7(b)(2)) The treatment residue,or extract of such residue,or the restricted waste identified above has been tested to assure that the treatment residues or extract meet all applicable treatment standards in 40 CFR 268.40 and/or performance standards In 40 CFR 268.45. 1 certify under penalty of law that I personally have axamined and am familiar with the treatment technology and operation of the treatment process used to support this certification. Based an my Inquiry of those individuals immediately responsible for obtaining this Informatdan,I believe that the treatment process has been operated and malMs[nod properly to as to comply with the treatment standards specified In 40 CFR 268.40 without Impermissible dilution of the prohibited waste. I am aware Uwe are significant penalties for submitting a false certification,including the possibility of fine and Imprisamnent. C. ❑ Restricted Waste Soil treated to ahemative standards 140 CFR 268.7(b)(4)) I certify under penalty of law that i have personally examined and am familiar with the treatment technology and operation of the treatmaflt process used to support this cartif cation and beReva that It has been maintained and operated property so as to comply with treatment standards specified In 40 CFR 258.49 without Impermissible dihrtlan of the prohibited wastes.I am swiss that there are significant penalties for submitting a false carttfkanon, Including the possibility of a fine and Imprisonment. D. ❑ Rostrictaid Waste Decharamazed But Requites Treatment For UNC(40 CFR 268.7(b)(4)IN)) I certify under penalty of law that the waste has been treated in accordance with the requirements of 40 CFR 268.40 or 268.49 to remove the hazardous characteristic.This dacha /zed waste contains Underlying Hazardous Constituents that require further treatment to meet treatment standards.I am aware that there are significant penalties for submitting a fats*tartlfkation,Including the passibility of a fine and Imprisonment. F. Restricted Waste Subject To Treatment(40 FFR 268.7(a)(2)) The restricted waste identified above must be treated to the appiicaftie treatment standards in 40 CFR 268.40,or treated to comply with applicable prohibitions set forth in Part 268.32 or RCRA Section 3004(d)and 268.49(c). If applicable,under 268.49,this contaminated soil ❑does or does not cortfatn listed hazardous waste and❑does or does not exhibit a charactaristle of hazardous waste aril Is subject to the soli treatment standards as provided by 26BA9(c)or the universal treatment standards. F, ❑ Hazardous Debris Subject To Treatment(40 CFR 268.45) This hazardous debris identified above must be treated to the alternative treatment standards In 40 CFR 268.45. I certify and warrant that the informatlon that appears on this form,and appended documents,Is true and correa i have correctly Indicated how my waste Is to be managed in accordance with 40 CfR 268.My certification is based on personal examination of the information submitted,or is based on my Inquiries of those Individuals responsible for obtaining the information. Authorized Signature-` Title: Agent Date: 04114/20 "HE and 59hateffool list(roam 40 OR Part Z68 4R and 268e0 avaltable upon re aevtsad SaJIJls t I C