LAND DISPOSAL NOTIFICATION AND CERTIFICATION FORM

1. This waste is a non-wastewaterwastewater (40 CFR 268.2)

2. This waste is subject to any California List restrictions which are checked below:

__HOC's __ PCB's __ Acid __ Metals __ Cyanides

3. Identify ALL USEPA hazardous waste codes that apply to this waste shipment, as defined by 40 CFR 261. For each waste code, identify the corresponding subdivision, or check NONE if the waste code has no subdivision. Also check which treatment standards apply.

ITEM	US EPA HAZARDOUS WASTE CODE(S)	SUBDIVISION ENTER THE SUBDIVISION DESCRIPTION IF NOT APPLICABLE SIMPLY CHECK NONE DESCRIPTION NONE	CONCENTRATION IN MG/KG UNLESS NOTED AS MG/L TCLP OR TREATMENT TECHNOLOGY	MGMT MTHD

MANAGEMENT METHODS (MGMT MTHD)

A. RESTRICTED WASTE REQUIRES TREATMENT

THIS WASTE MUST BE TREATED TO THE APPLICABLE TREATMENT STANDARDS SET FORTH IN 40 CFR PART 268 SUBPART D, 268.32, OR RCRA SECTION 3004(D).

B NON RCRA (APPENDIX IV OR V) LAB PACKS

"I CERTIFY UNDER PENALTY OF LAW THAT I PERSONALLY HAVE EXAMINED AND AM FAMILIAR WITH THE WASTE AND THAT THE LAB PACK DOES NOT CONTAIN ANY WASTES IDENTIFIED AT 268.42 (c)(2) . I AM AWARE THAT THERE ARE SIGNIFICANT PENALTIES FOR SUBMITTING A FALSE CERTIFICATION, INCLUDING THE POSSIBILITY OF A FINE AND IMPRISONMENT." (268.7(a)(8)).

C. RESTRICTED WASTES FOR WHICH THE TREATMENT STANDARD IS EXPRESSED AS A SPECIFIED TECHNOLOGY (AND THE WASTE HAS BEEN TREATED BY THAT TECHNOLOGY)

"I CERTIFY UNDER PENALTY OF LAW THAT THE WASTE HAS BEEN TREATED IN ACCORDANCE WITH THE REQUIREMENTS OF 40 CFR 268.42. I AM AWARE THAT THERE ARE SIGNIFICANT PENALTIES FOR SUBMITTING A FALSE CERTIFICATION, INCLUDING THE POSSIBILITY OF FINE AND IMPRISONMENT." (268.7(b)(5)(ii)).

D. RESTRICTED WASTE SUBJECT TO A VARIANCE

THIS WASTE IS SUBJECT TO A NATIONAL CAPACITY VARIANCE, A TREATABILITY VARIANCE, OR A CASE-BY-CASE EXTENSION.

E. WASTE IS NOT CURRENTLY SUBJECT TO PART 268 RESTRICTIONS

THIS WASTE IS A NEWLY IDENTIFIED WASTE THAT IS NOT CURRENTLY SUBJECT TO ANY 40 CFR PART 268 RESTRICTIONS.

I CERTIFY UNDER PENALTY OF LAW THAT I PERSONALLY HAVE EXAMINED AND AM FAMILIAR WITH THE WASTE THROUGH THE ANALYSIS AND TESTING OR THROUGH KNOWLEDGE OF THE WASTE TO SUPPORT THIS CERTIFICATION AS REQUIRED BY THE TREATMENT STANDARDS SPECIFIED IN 40 CFR 268 SUBPART D AND ALL APPLICABLE PROHIBITIONS SET FORTH IN 40 CFR 268.32 OR RCRA 3004 (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 FINE OR IMPRISONMENT. (268.7(a)(2)(ii))