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California Environmental Protection Agency Department of Toxic Substances Control <br /> STANDARDIZED PERMIT NOTIFICATION FOR EXISTING OR PROPOSED HAZARDOUS WASTE FACILITIES <br /> IX. REQUIRED ATTACHMENTS <br /> A. A scaled map to show the facility location including major freeways and cross streets. <br /> B. A scaled diagram to show the facility sitelplot map indicating the buildings, parking lots, <br /> and landscape areas. <br /> C. A scaled diagram to show the locations of hazardous waste management units to be <br /> permitted under the standardized permit. <br /> 5D A unit description information sheet for each of the hazardous waste storage and/or <br /> treatment units that will be under the Standardized Permit. <br /> X. OWNER CERTIFICATION <br /> "I certify that the unit or units described in these documents will meet the eligibility and operating <br /> requirements of state statutes and regulations for the standardized permit tier. I understand that I am <br /> required to provide financial assurance for this facility, and I am required to conduct a corrective action <br /> program as part of the standardized permit application to be submitted to the Department of Toxic <br /> Substances Control." <br /> "I certify under penalty of law that this document and all attachments were prepared under my direction or <br /> supervision in accordance with a system designed to assure that qualified personnel properly gather and <br /> evaluate the information submitted. Based on my inquiry of the person or persons who will manage the <br /> system or those directly responsible for gathering the information,the information is,to the best of my <br /> knowledge and belief, true, accurate and complete. I am aware that there are significant penalties for <br /> submitting false information, including the possibility of fines and imprisonment for known violations." <br /> Thom Foulks Vice President <br /> Name (Print r ype Title <br /> June 30, 2010 <br /> Signature Date Signed <br /> XI. OPERATOR CERTIFICATION <br /> "I certify that the unit or units described in these documents will meet the eligibility and operating <br /> requirements of state statutes and regulations for the standardized permit tier_ I understand that I am <br /> required to provide financial assurance for this facility, and I am required to conduct a corrective action <br /> program as part of the standardized permit application to be submitted to the Department of Toxic <br /> Substances Control." <br /> "I certify under penalty of law that this document and all attachments were prepared under my direction or <br /> supervision in accordance with a system designed to assure that qualified personnel properly gather and <br /> evaluate the information submitted. Based on my inquiry of the person or persons who will manage the <br /> system or those directly responsible for gathering the information, the information is,to the best of my <br /> knowledge and belief, true, accurate and complete. I am aware that there are significant penalties for <br /> submitting false information, including the possibility of fines and imprisonment for known violations." <br /> DTSC 1093A(0812006) DRAFT Page 6 <br />