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ofcx V7. ATTACHMENTS: �1 © I. .A plot planimap detailing the location(s) of the covered unit(s) to relation tothe facility boundaries.® 2. A unit specific notification form for each unit to be covered at this location. VII• CERTIFICATIONS: Thur form mutt 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 rhe facility(per title 12, California Code of Regulations (CCR) section 66170.11). All three copies mart have original signorine. waste MinbMiation I certify that 1 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 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 Permittiria 'Fran ion I certify that the unit or units described in these documents meet the eligibility and operating requirements of state statutes and regulation for the indicated permitting tier, including generator and seeondsry 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, 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 tnquir) of the person or person who manage the system, or those directly responsible for gathering the information, the information istc 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 violation. L.C. ANDERSON V.P. PERSONNEL & OFFICER OF Name (P r Type) lila Gxv* G�,l � 3 _ signature Date Sighed OPERATING REQUIRENEENTS: Please note that generators treating hazardous waste onsite are required to comply with a number of operating requirements which differ depending on the rier(s) under which one operates. 7liese, operating requirements are tet forth in the statutes and regulations, some of which are referenced in the 7-ter-Specific Factsheets. SUBNUSSION PROCEDURES: You must submit two reties of this completed notification by certified mail, return receipt requested, to: Department of Toric Substances Control Farm 1772 Onsite Hazardous Waste Treatment Unit 400 P Street, 4th Floor (walk In only) P.O. Boz 806 Sacramento, CA 93812406. You must also submit one ems of the notification and attachments to the local regulatory agency in your jurirdiuion as luted in rhe instruction marenais. You must also retain a copy as pan of your operating record. All three forms matt have original signatures, nor photocopies. DTSC 1772 (1193) Page 3