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Califoinia List - Effective - July 8, 1987 - please mark applicable numbers: 1) Liquid Hazardous Waste having a pil less than or equal to '2. 2 ) Liquid hazardous Waste containing PCB at or greater than 50 PPm- 3 ) Liquid Hazardous Waste that are primarily water and contains halogenated organic compounds (tiOC] in total concentration greater than or equal t-o ,1,000 ppm and less than 10, 000 pptn. 4 ) t,iquid Hazardous Waste, including free liquids associated with any solid or sludge containing ,petals that are greater than or egUal to those specified below. All rgpresented• in ppm. - Arsenic 500 Cadmium •100 Chromium 500 Lead 500 Metcury 20 Nickel 134 Selenium i00 'Thallium 130 Free Cyanide 1,000 A. I certify all information submitted is complete and accurate to the best of my knowledge. 4 !"11 h4 Printed/Typed Name Signature Date B. If you have treated the waste in compliance with the applicable standards specified in 40 CFR 268 Subpart D sign the following certification statement. I 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 treatmentistandards 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 submittin ,a false ' certification, including the possibility of a fine and imprisonment. 9 a Printed/Typed Name S griature Date C. Restricted waste subject to variance. List the specific variance: + I certify all information submitted is complete and accurate to the b st- of my knowledge. Print-�d/Typed Name S nalitre Date