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01, rg I'VaWfIcallon Form <br /> PWRA J'and., gposal.Res9deelo, <br /> Work Order <br /> Generster. us EPA ry-) <br /> No. <br /> PSC Profile Manifest <br /> NO. No. <br /> In accordance with 40 CFR 268.7(a), the underlying hazardous constituents must be addressed in this waste. Per <br /> 268.2(1), "underlying hazardous constituent"means any constituent listed in 268.48, Table UTS—Universal Treatment <br /> Standard which can reasonably be. aspected to be present at the point ofgeneration of the hazardous waste, at a <br /> concentration above the constituent-specific UTS treatment standard,. Refer to For ni-EZ (attached)for the waste <br /> code(s), treatability group, and subcategoiy applicable to this waste. <br /> In order to address underlying hazardous constituents in characteristic wastes,please check the appropriate box: <br /> 11 1 have reviewed the UTS list of 268.48,and per 268.7(a), I have determined that-there are no <br /> underlying hazardous constituents reasonably expected to be present in this waste. <br /> I have reviewed the UTS list of 268.48,and per 268.7(a),I have determined that underlying <br /> hazardous constituents are present in this waste. The underlying hazardous constituents are <br /> identified as follows: <br /> &hi i rA <br /> The determination of underlying hazardous constituents was based on: <br /> -91 Generator's knowledge of the waste <br /> 13 Analysis <br /> I certify that I personally have examined and am familiar with the waste through analysis and testing,or through <br /> knowledge ofthe waste to support this certification.I certify that as an authorized representative of the generator <br /> named above,all the information submitted in this notification is true and correct to the best of my knowledge, <br /> 4��A tw- <br /> ,,, <br /> t C' <br /> Printed Name Signature Date <br /> Form EZ Revised 07131/98 This is a two sided form <br />