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Land Disposal Restriction Notification & Certification Form

Generator Name:
USEPA ID Number:
EPA Hazardous Waste Number:
Date of Shipment: (mm/dd/yyyy)
This notification/certification is hereby submitted to MAX Environmental Technologies, Inc. in accordance with the requirements of 40 CFR 268.7.
Section 1
I have determined that the waste described on the above listed manifest is restricted in its present form and must be treated prior to land disposal. The applicable treatment standards are indicated below: (Check All That Apply)
Waste No. Subcategory Treatability Group D002 (pH£2) Acid Wastewaters D002 (pH£2) Acid Non-Wastewaters D002 (pH³12.5) Alkaline Wastewaters D002 (pH³12.5) Alkaline Non-Wastewaters D002 Other Wastewaters D002 Other Non-Wastewaters D004 (Arsenic) N/A Wastewaters D004 (Arsenic) N/A Non-Wastewaters D005 (Barium) N/A Wastewaters D005 (Barium) N/A Non-Wastewaters D006 (Cadmium) N/A Wastewaters D006 (Cadmium) N/A Non-Wastewaters D007 (Chromium) N/A Wastewaters D007 (Chromium) N/A Non-Wastewaters D008 (Lead) N/A Wastewaters D008 (Lead) N/A Non-Wastewaters D010 (Selenium) N/A Wastewaters D010 (Selenium) N/A Non-Wastewaters D011 (Silver) N/A Wastewaters D011 (Silver N/A Non-Wastewaters K062 N/A Wastewaters K062 N/A Non-Wastewaters
I have determined that the waste is restricted from land disposal based on the fact that the waste is a liquid hazardous waste containing the following metals: Check All That Apply
Nickel At Concentrations Greater Than Or Equal to 134 mg/l Thallium At Concentrations Greater Than or Equal to 130 mg/l
I have determined that the waste exhibits the characteristic of corrosivity (D002), is prohibited under 40 CFR 258.37, and contains the underlying hazardous constituents indicated in Table 1.
The treater will monitor the waste for the following constituents prior to land disposal:
Arsenic Nickel Barium Selenium Cadmium Silver Chromium Thallium Lead pH
Title:
Section 2 Waste Analysis Data: Attached Supplied Previously