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US Ecology, Inc. Land Disposal Restriction Form GENERATOR :ALEX GLAROS EPA I.D. NUMBER: Waste Stream or Profile Number:HAZARDOUS WASTE LIQUID Manifest Doc. No .Line No. Waste is a:Wastewater (<1% TSS and TOC)Non-wastewater Debris NOTIFICATION FREQUENCY:ONE TIME REQUIRED WITH EACH SHIPMENT Shipment EPA WASTE CODES (from 40 D006 D007 D008 CFR 268.40) UHC͛s (Underlying Hazardous Constituents 40 CFR 268.48)?Yes No If yes, list: Does a subcategory apply per 40 CFR 268.40 ?Yes No If yes, list: Constituents requiring treatment in F001-5,F039,debris, and alternate soils?Yes No If yes, list: A Restricted Waste Meets Treatment Standards (40 CFR 268.7(a) (3)) The restricted waste identified above meets the treatment standards in 40 CFR 268.40 or Alternative LDR treatment standards for contaminated soil 40CFR268.49 and can be landfill disposed without further treatment. If applicable, under 268.49, this contaminated soil does or does notcontain listed hazardous waste and does or dose not exhibit a characteristic of hazardous waste and complies with the soil treatment standards as provided by 268.49 (c) or the universal treatment standards. I certify under penalty of law that I personally have examined and am familiar with the waste through analysis and testing or through knowledge of the waste to support this certification that the waste complies with the treatment standards specified in 40 CFR Part 268 Subpart D. I believe that the information I submitted is true, accurate and complete. I am aware that there are significant penalties for submitting a false certification, including the possibility of a fine and imprisonment. B Restricted Waste Treated To Treatment Standards (40 CFR 268.7(b) (I) & 268.7 (b) (2)) The treatment residue, or extract of such residue, or the restricted waste identified above has been tested to assure that the treatment residues or extract meet all applicable treatment standards in 40 CFR 268.40 and/or performance standards in 40 CFR 268.45. I certify under penalty of law that I personally have examined and am familiar with the treatment technology and operation of the treatment process used to support this certification. Based on my inquiry of those individuals immediately responsible for obtaining this information, I believe that the treatment process has been operated and maintained properly so as to comply with the treatment standards specified in 40 CFR 268.40 without impermissible dilution of the prohibited waste. I am aware there are significant penalties for submitting a false certification, including the possibility of fine and imprisonment. C . Restricted Waste Soil Treated To Alternative Standards (40 CFR 268.7(b) (4)) I certify under penalty of law that I have personally examined and am familiar with the treatment technology and operation of the treatment process used to support this certification and believe that it has been maintained and operated properly so as to comply with treatment standards specifed in 40 CFR 268.49 without impermlssible dilution of the prohibited wastes. I am aware that there are significant penalties for submitting a false certification, including the possibility of a fine and imprisonment. D . Restricted Waste Decharacterized But Requires Treatment For UHC (40 CFR 268.7(b)(4)(iv)) I certify under penalty of law that the waste has been treated in accordance with the requirements of 40 CFR 268.40 or 268.49 to remove the hazardous characteristic. This decharacterized waste contains Underlying Hazardous Constituents that require further treatment to meet treatment standards. I am aware that there are significant penalties for submitting a false certification, including the possibility of a fine and imprisonment. E.Restricted Waste Subject To Treatment (40 CFR 268.7(a) (2)) The restricted waste identified above must be treated to the applicable treatment standards in 40 CFR 268.40, or treated to comply with applicable prohibitions set forth in Part 268.32 or RCRA Section 3004(d) and 268.49 (c). If applicable, under 268.49, this contaminated soil does or does notcontain listed hazardous waste and does or does not exhibit a characteristic of hazardous wastewater and is subject to the soil treatment standards as provided by 268.49(c) or the universal treatment standards. F.Hazardous Debris Subject To Treatment (40 CFR 268.45) This hazardous debris identified above must be treated to the alternative treatment standards in 40 CFR 268.45. I certify and warrant that the information that appears on this form, and appended documents, is true and correct. I have correctly indicated how my waste is to be managed in accordance with 40 CFR 268. My certification is based on personal examination of the information submitted, or is based on my inquiries of those individuals responsible for obtaining the information. Authorized Signature:{{Sig_es_:signer:signature}}Title:PROFILER Date:4/2/2024 UHC and Subcategory list from 40 CFR Part 268.48 and 268.40 available upon request Revision date: 11/1/16