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ta c"'C('-flogy !JS Ecology,Inc.Land 131sya;.af Restricti®n Form Generator; Universal Service Recycling ino EPA ID Number: CAL000355717 Waste Stream or profile Number: Manifest Doc.No. _ Line No. Waste Is a: ❑ Wastewater 14%TSS and TOC) ® Non-wastewater ❑ Debris T Notification Frequency: ® one Time ❑ Required with Each Shipment Shipment EPA Waste Codes(from 40 CFR 268.40) D002 UHC's(Underlying Hazardous Constituents 40 CFR 266.48)7 11 Yes 0 No If yes,Itst: v Does a subcategory apply per 40 CFR 268.407 n Yes P1 No If yes,list: High TOC ignitable Characteristic Liquids Constituents requiring treatment to F001-S,F039,debris,and alternate soils? 13 Yes 0 No If yes,list: © See Profile for analysis(If any). A. ❑ Restricted waste Meets Treatment Standards(40 CFA 261L7(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 CFft268A9 and can be landfill disposed without further treatment. If applicable,under 269.49,this contaminated salt[3 does or❑does not contain listed hazardous waste and does or not exhibit a characteristic of hazardous waste and complies with the soli treatment standards as provided by 268.49(c)or the universal treatment standards, I certify under penalty of law that t personally have examined and am famillar with the waste through analysis and testing or through knowledge of the wash to support this certification that the waste complies with the treatment standards specified In 40 CFR Pant 268 Subpart D.I believe that the Information I submitted is true,accurate and complete.t am aware that there are significant penalties for subromng a false certification,Including the Possibility of a fine and imprisonment. B. ® Restricted waste Treated To Treatment Standards(40 CFR 268.7(b)(1)&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. I artffy under penalty of taw that t personalty have examined and am familiar with the treatment technology and operation of the treatment process used to support this certification. based on my Inquiry of those Individuals immediately responsible for obtaining this Information,I believe that the treatment process has been operated and maintained property so as to comply with the treatment standards specified in 40 CFR M0 without Impermissible dilution of the prohibited waste, 1 am aware there are slgrtlficant penattles for submitting a false certification,including the possibiltty of One and Imprisonment. C. ❑ Restricted Waste Soil treated to alternative standards(40 CFR 268.7(b)(4)) 1 certify under penalty of law that 1 have personally examksed and am famlitar with the treatment technology and operation of the treatment process used to support this certification and believe that it has been maintained and operated properly so as to comply with treatment standards specified in 40 CFR 268.49 without Impermissible dilution of the prohibited wastes,i am aware that there are significant penalties for submitting a false certification, Including the possibility of a fine and Imprisonment. D. ❑ Restricted waste Decharaftrized But Requlrea Treatment For UNC(41)CFR 268.7(b)(4)(lv)) I certify under penalty of law that the waste has been treated In accordance with the requirements of 40 CFR 268.40 or 269.49 to roman the hazardous characteristic.This dacharacterized waste contains Underlying Hazardous constituents that require further treatment to meet treatment standards.I am aware that there are sidnificarfi panatties for submitting a false certification,including the possiblitty of a fine and hnprisoriment. £. 2] Restricted waste Subject To Treatment(40 CFR 268.7(a)(2)) The restricted waste identified above must be treated to the applicable treatment standards In 40 LFR 268.40,or treated to comply with applicable prohibitions set forth in Part 268.32 or RCRA Section 3004(d)and 268.49(c). It applicable,under 268419,this contaminated sail ❑does or D does not contain listed hazardous waste and i[does or W does not exhibit a characteristic of hazardous waste and is subject to the soil treatment standards as provided by 268.49(c)or the universal treatment standards. F. ❑ Hazardous Debris subject To Treatment(40 CFR 26885) This hazardous debris Identified above must be treated to the alternative treatment standards in 40 CFR 268.45. i certify and warrant that the information that appears an this form,and appended documents,is true and correct.i have correctly Indicated how my waste Is to be managed In accordance with 40 CFR 268.PRY eestt(Heatltrn Is based an personal examination of the Information submitted,or Is based on my inquiries of those individuals responsible for o ining the Information. Authorized Signature: 91Title: Apnt Date: MINI 20 UHC and Suhgtegory fig from 40 CER Part 268A atd268.40 avalla�(bie won m nest, Rswked I?/VIS