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Applicable Certifications <br /> ,i.Authorized Representative <br /> Crosby&Overton Profile Number Manifest and line Item Number associated with waste shipment <br /> 101 9164885JJK & 9b.1,9b.2, <br /> CHECK THE APPROPRIATE CERTIFICATION <br /> ��lnerator's Certification(268.7(a)(2)(U))for waste that meets Treatment Standards <br /> I certify under penalty of law that I personally have examined and am familiar with the waste through analysis and <br /> testing or through knowledge of the waste to support this certification that the waste compf ies with the treatment <br /> standards specified in 40 CFR,Part 268 Subpart Q and all applicable prohibitions set forth in 40 CFR 268.32 or RCRA <br /> Section 3004(d).I believe that the information I submitted is true,accurate and complete.i am aware that there are <br /> significant penalties for submitting a false certification, including the possibility of a fine and imprisonment. <br /> 2.Waste Treated to Remove Characteristics(268.7(b)(5)00 <br /> 1 certify under penalty of law that the waste has been treated in accordance with the requirements of 40 CFR 268.40 <br /> to remove the hazardous characteristic.This decharacterized waste contains underlying hazardous constituents that <br /> require further treatment to meet universal treatment standards.I am aware that there are significant penalties for <br /> submitting a false certification including the possibility of fine and imprisonment. <br /> 3.febris Treated to meet Alternative Standards(2681(d)(3)(110) <br /> I certify under penalty of law that the debris has been treated in accordance with the requirements of 40 CFR 268.45.1 <br /> am aware that there are significant penalties for making a false certification including the possibility of fine and <br /> imprisonment. <br /> 4.Lab Packs to be Treated by Incineration(Certification must be completed.)Appendix iV Lab Packs <br /> I certify under penalty of law that I have personally examined and am familiar with the waste and that the lab pack <br /> contains only wastes which have not been excluded under Appendix IV to 40 CFR Part 268 or solid wastes not subject <br /> to regulation under 40 CFR Part 267.1 am aware that there are significant penalties for submitting a false certification, <br /> including the possibility of fine or imprisonment. <br /> 5.Appendix V Lab Pack: <br /> I certify under penalty of law that i personally have examined and am familiar with the waste through analysis testing <br /> or through knowledge of the waste and that the lab pack contains only organic waste specified in Appendix V to part <br /> 268 or solid wastes not subject to regulation under Part 261.1 am aware that there are significant penalties for <br /> submitting a false certification,including the possibility of fine or imprisonment. <br /> Signature Print Name <br /> Title Date <br /> 3 of 5 <br />