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Clean Earth Environmental Solutions <br /> RCRA Land Disposal Restriction Notification Form <br /> Work Order # <br /> Generator: <br /> US EPA ID <br /> V <br /> a�7Profile No. No. <br /> –7 /„ co Manifest �'I^�JJ1 <br /> ` lY No. _ (P <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 expected to be present at the point of generation of the hazardous haste, 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 /> 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 /> ❑ 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 /> The determination of underlying hazardous constituents was based on: <br /> 0 Generator's knowledge of the waste <br /> ❑ 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 the information submitted in this notification is true and correct to the best of my knowledge. <br /> Printed Name Signature Date <br /> cAk4wMA CO-" <br /> Form EZ Revised 07/31/98 This is a two sided form <br />