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RCRA Land Disposal Restriction Notification Form �� Ll 37Oz- <br /> Work Order # <br /> Generator: ��� �� /1� S l j US EPA ID <br /> "� No. l(� <br /> Profile No. C'1�a1� "U�/ g3�')1,��—(�i �Moanifest v(��,�_7I� �°�T– <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-4Iniversal Treatment <br /> Standard which can reasonably be expected to be present at the point of generation of the hazardous waste, at a <br /> concentration above the constituent-specific UTS treatment standard. Refer to Form-EZ (attached) for the waste <br /> code(s), treatability group, and subcategory applicable to this waste. <br /> In order to address underlying hazardous constituents in characteristic wastes,please check the appropriate box: <br /> CY'l 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 /> ❑ 1 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 /> The determination of underlying hazardous constituents was based on: <br /> 0 Generator's knowledge of the waste <br /> 0 Analysis <br /> I certify that I personally have examined and am familiar with the waste through analysis and testing,or through <br /> knowledge of the waste to support this certification. I certify that as an authorized representative of the generator <br /> named above,all theinformation submitted in this notification is true and correct to the best of my knowledge. <br /> &arry n- '1''nn n^ A /-/3-72 / <br /> Printed Name Signat • Date <br />