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EPA ID NUMBER 00 Page 3 of 7 VIII. 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-making functions that govern operation of the facility(Der Title 22, California Code of Regulations (CCR) Section 66270.11). Al!three copies must have original signatures. Waste Minimization I certify that I have a program in place to reduce the volume, quantity, and toxicity of waste generated to the degree 1 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 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 provide the required financial assurance for closure of the treatment unit by October 1, 1996. 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, accitrate, and complete. 1 am aware that there are substantial penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations. T/M L Efi G 9Al �i QFcrp,� of Cn a�orvFiE v�.a� Arf,4ies N/ a (Print or Type) / Tule :S' nature d / Date Signed REQUESTING A SHORTENED REVIEW PERIOD: Generators operating under CA and/or CE are legally authorized to operate 60 days after submitting a complete notification. DISC may shorten the time period between notification and authorization when the owner or operator establishes good cause. If you need to be authorized sooner than the standard 60day period, please check the box below and state the reason. Your authorization will be automatically effective on the date your completed notification form is received by DISC. (Use additional sheets, if necessary.) YES ® Reason: 0,"14A/6E OF OwuEPS�/iP 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 der(s). These operating requi:ements arc set forth in the statutes and regulations, some of which are referenced in the Tier-Specific Fad Sheets available from D7SC's regional and headquarters bffices. SUBMISSION PROCEDURES: All three forms must have originssignatures, not photocopies. You must submit two eooles of this completed notification by certified mail, return receipt requested, to: Department of Toxic Substances Control Program Data Management Section, HQ-10 Atm: TP Notifications- Form 1772 400 P Street, 4th Floor, Room 4453 (walk in only) P.O. Box 806 Sacramento, CA 95812-0806 You must also submit one coov of the notification and attachments to the loc>I regulatory agency in your jurisdiction as listed in Appendix 2 of the instruction materials. You must also retain a copy as part of your operating record. LAj—v, DO NOT SEND YOUR FEE PAYMENT M.H THIS FORM. DISC 1772 (1/96) Page 3