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CAL 930603608 ./ Page_of EPA ID NUMBER ..r tion Renewal Form is; IIVr^vR"'Trim CTSTIIS: The information in the Notifica - ❑ 1. Unchanged and correct. r 2: 09 ❑ 2. Incorrect and altered to reflect the hazardous waste activity of the facility. 3. Ammended to reflect operational changes of the facility, changes which have occured since the last notification (include attachments if applicable). Note: If adding new treatment units use the Unit Specific Form (1772D). Cerdfiomion This form must be signed by an authorized corporate officer or any other person in the company who has operational control and performs decision-making functions that govern operation of the facility (per title 22, California Code of Regulation' (CCR) section 66270.11). All three copies must have original signatures. Waste Minimisation I certify that I have a program in place to reduce the volume, quantity, and toxicity of waste generated to the degree I have determined 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 Petmittine Certification I certify 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 that if any of the units operate under Permit by Rule or Conditional Authorization, I will also be required to provide required financial assurances by January 1, 1995, and conduct a Phase I environmental assessment by January 1, 1995. I certify under penalty of law that this document and all attachments were verified. corrected, ammended and/or 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. ttl,N, anaa-"✓ Jeffrey S . Braden Name (Print or Type) Title �� y/A l y Signature Date Signe OPERATING REQUIREMENTS: Please note that generators treating hazardous waste onsite are required to comply with a number of operating requirements which differ depending on the tier(s)under which one operates. These operating requirennents are set forth in the statutes and regulations, some of which are referenced in the Ter-Specific Factsheets. SUMSSION PROCEDURES: You must submit run mnits of this completed notification by certified nail, return receipt requested, to: Department of Toxic Substances Control Form 1772 RENEWAL Onsite Hazardous Waste Treatment Unit 400 P Street, 41h Floor (n•alk in onl)) P.O. Box 806 Sacramento, CA 95812-0806. You must also submit one con of the notification and anachmenn to the local regularan agenn, in Your jurisdiction as listed in the instruction materials. You must also retain a copy as part of your operating record.