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State of California-California Environmental rrotection Agency Department of Toxic Substances Control Privacy Statement Applicable to Individuals Pursuant to Government Code section 11019.9 and Civil Code section 1798, et seq., this information is requested by the Department of Toxic Substances Control, Hazardous Waste Management Program under Health and Safety Code section 25245 in order to verify adequate financial assurance of hazardous waste facilities and transportable treatment units. Completion of the applicable form or submission of a document containing the wording specified in California Code of Regulations, title 22, section 66264.151 is mandatory. The consequence of not completing the form (or a document containing the specified wording) is denial of a permit to operate a hazardous waste facility or transportable treatment unit. Information may be provided to various government agencies including, U. S. Environmental Protection Agency, State Attorney General, California Environmental Protection Agency,Air Resources Board, California Integrated Waste Management Board, Energy Resources Conservation and Development Commission,Water Resources Control Board and California Regional Water Quality Control Boards. This information may be subject to disclosure under the Public Records Act(Government Code section 6250, et seq.). Section 1798.3, Civil Code defines an individual as a"natural person." For more information or access to your records (in Imperial and Trinity Counties only), contact: Chief Financial Assurance Section Enforcement and Emergency Response Program Department of Toxic Substances Control 8800 Cal Center Drive, 3rd Floor Sacramento, California 95826 (916) 255-3628 All other jurisdictions should contact their local county COPA. State Privacy Policy Pursuant to Government Code Section 11019.9, all departments and agencies of the State of California shall enact and maintain a permanent privacy policy, in adherence with the Information Practices Act of 1977(Civil Code Section 1798 et seq.), that includes, but not necessarily limited to, the following principles: (a) Personally identifiable information may only be obtained through lawful means. (b)The purposes for which personally identifiable data are collected shall be specified at or prior to the time of collection, and any subsequent use of the data shall be limited to and consistent with the fulfillment of those purposes previously specified. (c) Personal data may not be disclosed, made available, or otherwise used for a purpose other than those specified, except with the consent of the subject of the data, or as required by law or regulation. (d) Personal data collected shall be relevant to the purpose for which it is needed. (e) The general means by which personal data is protected against loss, unauthorized access, use, modification, or disclosure shall be posted, unless the disclosure of those general means would compromise legitimate agency objectives or law enforcement purposes. Each department shall implement this privacy policy by: • Designating which position within the department or agency is responsible for the implementation of and adherence to this privacy policy; • Prominently posting the policy physically in its offices and on its Internet website, if any; • Distributing the policy to each of its employees and contractors who have access to personal data; • Complying with the Information Practices Act(Civil Code Section 1798 et seq.), the Public Records Act(Government Code Section 6250 et seq ), Government Code Section 11015.5, and all other laws pertaining to information privacy, and • Using appropriate means to successfully implement and adhere to this privacy policy. DTSC 1155U(01/29/2008) Instructions Page 2 of 2