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IDNUMBER CAD9825102BI STANDARDIZED PERMIT NOTIFICATION FOR EXISTING HAZARDOUS WASTE FACILITIES 1X. REQUIRED ATTACHMENTS ® A. A scale drawing of the facility. B. Photographs of the facility. ® C. A topographic map of the facility. ® D. A unit-specific information sheet for each of the hazardous waste storage and/or treatment units included in Item F which will be under the Standardized Permit. Do not submit unit-specific information sheets for units under PBR, Conditional Authorization or Conditional Exemption. ® E. Documents demonstrating compliance with Chapter 15, Article 8 or with Sections 67450.13 and 67450.15 requirements for financial responsibility, whichever is appropriate for this facility. X. OWNER CERTIFICATION 21 certify that the unit or units described in these documents meet the eligibility and operating requirements of state statutes and regulations for the standardized permit tier. I understand that I am required to provide financial assurances with this notification, and will be required to conduct a corrective action program as part of the standardized permit application to be submitted to the Department at a later date." "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 complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for known violations." GAYLE HARRELL VICE PRESIDENT Name (Print or Type) Title Signature ( Date Signed XI. OPERATOR 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 standardized permit tier. I understand that I am required to provide financial assurances with this notification, and will be required to conduct a corrective action program as part of the standardized permit application to be submitted to the Department at a later date. '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 complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for known violations." MIKE HARRELL SERVICE MANAGER Name (Print or Type) Title tip,Z _�=' '�f `3 - '-Z Signature Date Signed DTSC 1093 (1/93) DRAFT - January 27, 1993 Page