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Path:s of <br /> «• -ERTIFICATIONS: This form must oe sten by a� artrnonzed mraorate omcer or anv otner person in We mnmzav wmr <br /> liar operational control and performs aension-mmane functtorts tnai govern <br /> Code operation or rhe facility(Per Tuk 22. Ga ifaratc <br /> of Regulations /CCRI Section b6270.111. All three cvpia mart haw original signanoa_ <br /> Minimiza on i centiv that I have a program in place to Induce the voiume. quantity, and toaaci of wase ISS to Me <br /> � podegree i have determines to be ec000nucaily pncaeable &= that I have selected the practicable method of trrawent, raanae, o: <br /> disposal ctirrentiv ayshle. L1 "Y' which m.ni mir.�e ( I and future Ihre81 <br /> Prim to human health Lou the cm=--==L <br /> Tiered Permitting (insist( cervfy that the stmt or traits described in these documents Inca the eligibilityand <br /> requirements of state statutes rad regtiiatio= for the indicated oae+annr <br /> requirements. I understand that if any of the touts ptrmtMing net. including generator and secondary containment <br /> m provide required financial .�a,nn operate tinder Permit by Rule or Conditional Authorization. I will also be ramirec <br /> assurance for cloacae of the treatment unit by January I, 1995. <br /> I certify under penalty of law that this document and all anAC11me- <br /> with a system designed to assure that qualified at were d eprevail�tender Or direction m tted. Blind in my vialan <br /> 4 Personnel properly gather and evaluate the information submitted. 13aaed on my imwn <br /> Of the person or persons who manage the system, or those directly responsible for gathering the information. the mfamanoe is.It <br /> the best of my knowledge and belief, true, accurate, and complete. <br /> 1 am aware that there aro substantial penalties for submitting false information, including the possibility of fines and impmw a <br /> for knowing violations <br /> 9fi'.ce t^;issel <br /> Quality Assurance Coordinator <br /> Name (Print or Type) Title <br /> ,4 <br /> Signature t 08-310-95 <br /> Date Signets <br /> 1 <br /> OPERATING REQUIREMENTS. <br /> Please note that generators treating hazardous waste onsite are required to comply with a number of operating negaavv miss mi <br /> differ depending on the rier(s). Tum operating requirements are ser forth in the statures and regulations, save of whick ata <br /> referenced in the Ter-Specrfic Fact Sheers available from the Department's regiomi and headquarters officer. <br /> SUBMISSION PROCEDURES: <br /> You mural submit two copier of this completed notification by certified mail, return receipr requested, to: <br /> Department of Toxic Substances Conrroi <br /> Program Data Management Section <br /> 400 P Street, 4th Floor, Room 4453 (walk in only) <br /> P.O. Bas 806 <br /> Sacramento, Calk 95812-0806. <br /> You must also submit one cow of the notification and attachments to the local regulatory agency in your jurisdiaaon as dsard a <br /> Appendix 2 of the instruction materials. You must also retain a copy as part of your operating record. <br /> il�three forma mac haat orieina!signarraa. rias phoracopiQ. <br /> DTSC 1772 (1/95) Pine <br />