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, <br /> rt Constituents to be Monitored <br /> F039(Constituents to be monitored must be indicated.Use Form LDRN-1 A) <br /> F001-F005,D001 (other than residues from RORGS or CMBST),D002,D012-DO43(Underlying constituents must be indicated. <br /> Use from LDRN-1 A) <br /> Defined:An underlying constituent includes any constituent listed in 268.48.Table UTS-Universal Treatment Standards,except Zinc, <br /> which can reasonably be expected to be present at the point of generation of the hazardous waste a concentration above the <br /> constituent specific UTS treatment standard. <br /> _The waste is a characteristichazardous waste D001 or D002 which is intended for treatment/disposal in a CWA system, <br /> CWA-equivalent system,or Class I SDWA system.Underlying Hazardous Constituents(UHC's)are NOT required to be identified. <br /> The waste is a characteristic hazardous waste D001 High TOC Ignitable Liquids Subcategory(i.e.,greater than or equal to 10%TOC). <br /> Pursuant to 40 CFR 268.40,the waste must be treated using organic recovery(RORGS)or combustion technology.UHC's are NOT <br /> required to be identified. <br /> _Check here if the waste is a D012-17 non-wastewater or a D018-43 that is intended to treated in a CWA system,CWA-equivalent <br /> system,or Class I SDWA system.If so,the waste is EXEMPT from the LDR regulations,and no further information is required. <br /> Deadline Extensions and Variances <br /> Certain wastes may be subject to a deadline extension or variance(e.g.treatability,variance,case-by-case extension).Describe below <br /> any extension that applies to a waste in this waste shipment(include dates and waste codes). <br /> NOTICE: <br /> This section must be completed(attach additional sheets if necessary) <br /> Basis for this certification.Describe the knowledge upon which the certification is made. <br /> ARE THERE ANY CONSTITUENTS WHICH DO NOT MEET APPLICABLE LDR TREATMENT STANDARDS? <br /> If yes,please list the constituents which require further treatment. <br /> Waste Code • <br /> Signature Printed Name Date <br /> 2of5 <br />