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SJ`ericstcte �,lvirout,?em'aI ,Solltriol?s <br />nrsbosrl t�lric!'ivlf !Vpiicr/tlwt Nararr <br />��aera�or; �arlt Order <br />�� ; � ,til /7 l EPA 3 <br />U5 EID <br />PSC <br />PrroillerV, <br />L % •1 ter} t,.. 4 t <br />li7 f1CCC11' ' r `✓ �.ti.a � . <br />na1,Ge with u f n <br />J UNP, 26' <br />--'dd,?(j�, Jttrrrdel•h � . Jud•%tC+�, ire Fu7dal�i�rf% �rr::�r-aa:rs co?25tf ? <br />lj'To I7q,-n1'r1o7rS Ca?JS:1'lef�f?i "!i?v iii Q/r, C = L'17iS must /J2 t7- PSS?rJ til Ih15 1!' 7512, � <br />�ra17ac7rc' L lzicl7 c J �itStinlE;2t listset 1J7 ? <br />^0120212 Rlt i•-_+(7S41i:tO11' be zrpecifd tO :. 6G• C� .�'al��e �.tTS--J, i <br />il'.?itOrt C7DOlic� Sha cor7st7ltre17r-s ecitrc u � p• 2se;7f of (J,C pOillr' 0-c_ 17.^Je1Sal Ji.eC117"e171 <br />rUCi?(Sf, r:•earaoili Y ,r JS ('/2atli12i9i J p�372TQt1O77 of 1h6 ha,:a1-Gp7JS ivaatc, (ff Q <br />i(U, a72d S??IiCOC"+c stal7clarcl. Re e!• to ,Fon?`E— <br />Oi�t aDD:SCRI7IM to tielS wdsre. (001ci7ed) Jo7- 117e <br />lit 0'-d"" t0 R[l21•ZS <br />S ulidel•lvM haagi, offs conshFiiwitS l`J: CJ'1�'QCtPI'1StiG tit'USI¢S, picase C/jeck 11=2 C1gnj.UJJ/'iLiiE <br />r ! haVB reV'rECira U i S <br />�dBTI c tr±G list o ?68.4e, ar?d ti8!• 7 <br />Ping ha�a dou 68• i Ca)> I have determined tha <br />S COI?5t1� 2�L�iS 1'E2SOY!3'oly e:1u„cted to be �1e'"e are no <br />present,2a this �..v ;- <br />,a� T lzaJe ras'' a5:�, <br />zewed the UTS list of 268.40', <br />and > <br />hazardous coE]sti��e aer _©8.i(a)1 have dete <br />?ts are Present in this waste. The ; r_ rmh�ed that unciellyb?4 <br />xdentifted as iollo;;ts: u��ce-13`x; hazardous constituei,= r <br />fFG� r �- <br />2(@iTrFil2aYlOH OJ i(J2C?S?"I.y Tic i7aS11 C O7tS CO1tSi1t212?7iS :PGS t7 ?SCC Q?;' <br />Generator's 1c"10Vv edge�raste <br />i CettiFv that I Pet'sonGll,t a, <br />:_�Fou�ledge o- h_�e exat7ined and e <br />R Pltg LL'2Stz C� tYi iaiItll?ci tilt? �!I8 i;r89t8 tl2rOU <br />nz177e1 a sc anon rbis c� ?F7'c&tion. I c�rr, r 9h 27alysis anc� tesd7.75, o. -z <br />-bone: 3�) ihC in"o.- x ion submlrczd int � rhatas hrougb <br />his notil7caiio is �' cuthorl�ed renresentaIive of fire jeaerator <br />true and correct to the best of rzy kno�t�I-13 <br />'-` Ied Namae ______ _-_- <br />e. <br />iLL <br />'Date <br />Y l'12. <br />in �`' Reuised ll9/,II9a <br />This is 2 t1V0 sided form <br />