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Clean Earth EnvirounteaudSolnttanS <br /> RCR9 Land Disposal Restriction Notification Form <br /> Work Order ii <br /> Generator: US EPA ID <br /> No. <br /> I <br /> Proftio No. � No n3fest <br /> In accordance with 40 CFR 268.7(a), the underlying hazardous constiluents must be addressed in this waste. Per <br /> 268.2(1), "underlying hazardous constituent"means any constituent listed in 268.48, Table UTS--Universal 71•eatment <br /> Standard which can reasonably be expected to be present at the point tit'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 /> cade(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 /> ❑ I 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 I have reviewed the UTS list of 268.48,and per 268.7(x),I have determined that underlying j <br /> hazardous constituents are present in this waste. The underlying hazardous constituents are <br /> identified as follows: <br /> _..__C`.)zrb Wit, <br /> I <br /> I <br /> The determination of underlying hazardous constituents was based oil• <br /> ® Generator's knowledge of the waste <br /> 11 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 /> warned above,all the information submitted in this notification is true and correct to the best of my knowledge. <br /> Printed Name <br /> Signature Date <br /> Form EZ Revised 07/31/95 This is a two sided form <br />