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EPA ID NUMBER CALO(, 132271 Page ] o(� VI. ATTACHMENTS: ® I. A plot plan/map detailing the location(s) of the covered units) in relation to the facility boundaries. ® 2. A unit specific notification form for each unit to be covered at this location. VII. CERTIFICATIONS: This form must be signed by an authorized corporate officer or any other person in the company who has operational control and performs decision-minting functions that govern operation of the ad Code of Regulations (CCR) section 66270.11). All three copier nut venthaorlgbaal signarrrrars. tele 22, California Waste Minimization I certify that I have a program in place to reduce the volume, quantity, and toxicity of waste generated ro the degree I have determined to be economically practicable and that I 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 certify that the unit or units described in these documents meet the eligibility and operating requirements of state seswtes and regulations for the indicated permitting tier, including generator and secondary cont-;nam requirements. I understand that if any of the units operate under Permit by Rule or Conditional Aut orizadon,I will alao be required to provide required financial assurances by January 1, 1994, and conduct a Phase I environmental assessment by January I. 1995. 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 completes I am aware that there are substantial penalties for submitting false information, including the possibility of fines and imprisaoment for knowing violations. R . Kim Meyer Plant Supervi'sor Name (Print Type) pp Title -!4/773 Signature I Date Signed a OPERATING REQUIREMENTS: Please note that generators treating hazardous waste onsite are required to comply with a number of operating requirements wlddr differ depending on the tier(s) under which one operates. There operating requirements are sa forth in the statutes and regulations, some of which are --erenmd in the Ver-Sperdfre Fsasheas, SUBMISSION PROCEDURES: You must submit two ovvitt of this completed noricadon by certified mail, return receipt requested, to: Department of Toxic Substances Control Form 1772 Onrite Hazardous Waste Treatment Unit 400 P Street, 4rh Floor(lvalk in only) P.O. Bax 806 Sacramento, CA 95812-0806. You must also rubrnU one ensu of the notification and attachments to the local regulatory agency In your jmoisdierion as Rsted in rhe instruction materials. You must also retain a copy as parr of your operating record All three forms must have original signatures, not photocopies.