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EPA ID NUMBER rnr nnnt a t Page 3 of 6 VIII• CERTIFICATIONS: This form must be signed by an authorized corporate officer or any other person rn the companv who has a of Regulations control and performs decision-making functions that govern operation of the facthry(per Title 22. California Code of Regulations tCCRI Section 66270.11). All three copies must have original signatures. Waste Minimization 1 certify that I have a program in place to reduce the vOiume. quantity, and toxicity of waste generated to the degree I have deterramed to be economically practicable and that 1 have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health and the environment. Tiered Permitting Certification I certifv that the unit or units described in these documents meet the eligibility and operating requirements of state statutes and regulations for the indicated permitting tier, including generator and secondary containment requirements. I understand [hat if anv of the units operate under Permit by Rule or Conditional Authorization, I will also provide the required financial assurance for closure of the treatment unit by October 1. 1996. I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those directly responsible for gathering the information, the information is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are substantial penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations. TERRY BURNSIDE Name 1Pnat or Type) VICE PRFGrnntam-""x'DrHANDrcr i Tule Signature Cc IX. Date Sig REQUESTING A SHORTENED REVIEW PERIOD: Generators operating under CA and/or CE are legally authorized to operate 60 days after submitting a complete notification. DISC may shortenrhe rime period between nodficarion and :urhommnon when the owner or operator establishes good cause. If you need to be authorized sooner than the standard 60-day period, please check the box below and state the reason. Your authorization will be automatically effective an the date your completed notification form is received by DISC. (Use additional sheers, if necessary.) YES Reason: OPERATING REQUIRE1fENTS: Please note that generators treating hazardous waste onsue are required to comply with a number of operating requirements which differ aeoending on the nerrs). These operating requirements are set forth in the statutes and regulations, some of which are rcferenced in the Tier-Spectfic Fact Sheets available from DTSC's regional and headquarters offices. SUBMISSION PROCEDURES: All three forms must have ori inal signatures, not photocopies. You must submit two copies of this completed notification by certified mail, return receipt requested, to: Deparrment of Toxic Substances Control Program Data Management Section, HQ-10 Attn: TP Notifications - Form 1772 100 P Street. 4th Floor, Room 4453 (walk in only) P.O. Box 806 Sacramento. CA 95812-0806 You must also submit one copy or the notification ana attachments to the local regulatory agency in your jurisdiction as listed in Appendix 2 or the mstruction materials. You must also retain a copy as pan of your operating record. PLEASE. DO NOT SEND YOUR FEE PAYMENT WITH THIS FORM. DTSC 1772 (1/96) Page 3