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03-26-96 11 . 13AM FROM DTSC RF'"ON 1 FP/S&E TO 912094771304 P003/003 <br /> Page 3 of <br /> EPA ID NUMBER <br /> cer or <br /> other <br /> on <br /> n the <br /> . has operational ional control and performs decision making functions that go e n ONS: 7hisfiorm must be s igned by an authorized corporateoration of thefacili�(perr7ltle 22, California <br /> Code of Regulations (CC)?) Section 66270.11). All three ovpim"tall have orlginaJ'dgnatswm: <br /> 1Mcle MSnimizalion I certify that I have a program in place to reduce the volume, quantity, and toxicity of waste generated to the <br /> degree I have determined to be economically practicable and that 1 have selected the practicable method of treatment, storage, or <br /> disposal currently available to me which minimizes the present and future threat to human health and the environment. <br /> Tiered --Mine Certification 1 certify that the unit or units described in these documents meet the eligibility and operating <br /> requirements of state statutes and regulations for the indicated permitting tier, including generator and secondary <br /> utiellt <br /> der Perrait by Rule or Conditional Authorisation.I will also be required <br /> requirements. 1 understand that if any of that anis operate un <br /> to provide required financial assurance for closure of the treatment unit by January 1, <br /> ce <br /> I certify under penalty of law that this document and all attachmentsr <br /> prepared <br /> with a systemdesigned to assure that qualified personnel properly gather and eve the int rmatioo submitted.under my direction or supervision <br /> on Inquiryy <br /> of the person or persons who manage the system, or those directly responsible for gathering the information• the information is, to <br /> the best of my knowledge and belief, true, accurate, and complete. <br /> I am aware that there are substantial penalties for submitting false information, including the possibility of fines and imprisonment <br /> for knowing violations. `C, <br /> Title <br /> Name(Print 9rqype) 2 <br /> V ( v� iVl^ fC w J d <br /> Date Signed <br /> Signature <br /> OPERATING REQUIREMENTS: <br /> Please note that generators treating hazardous waste onsite arc required to comply with a number of operating requirements which <br /> differ depending on the tier(s). These operating requirements are set forth in the statutes and regulations, some of which are <br /> referenced in the 7Jer•Speciftc Fact Sheers available from the Department's regional and headquarters offices. <br /> SUBNIISSION PROCEDURES: <br /> you must ini&nili two comes of this completed notification by certified mail, return receipt requested, to: <br /> Department of Toxic Substances Control <br /> Program Data Management Section <br /> 400 P Street, 4th Floor, Room 4453 (walk in only) <br /> P.O.•Bos 806 <br /> Sacramento, CA 95812.0806. . <br /> to the <br /> local <br /> ory agency in <br /> AYou must also submit one ppendls 2 of the instruction materials. you must also ron and etain attachments as P rt f your Perat ng record.your jurisdiction as listed in <br /> Ali thrrejomu must have ortriwl signatures, nW Phot0WP'er• <br /> Page 3 <br /> DTSC 1772 (1/95) '-+ <br />