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SX Clean Harbors Environmental Services, Inc. California Land Disposal/Restriction Information Notification/Certification Form This form is submitted in accordance with the requirements of 22 CCR 66268.7(x)Chapter 18 which restricts land disposal of certain hazardous wastes. The appropriate California waste code(s)and applicable non-RCRA hazardous waste listings from CCR 66268.29 are noted below.Complete all portions of Part I. If the waste is non- hazardous or not restricted then complete only the applicable portions in Part I and sign/date the Form at the bottom of page. Otherwise complete Part I, II,and III, and sign/date the Form at the bottom of page. (For RCRA wastes,use Clean Harbors RCRA FORMS) I. GENERAL INFORMATION REGARDING GENERATOR&WASTE STREAM DTE Stockton LLC PHONE: 209-32x3712 SITE_2526 West Washington Street Stockton,CA 95203 PROFILENUMBER: CH1346380 IS THIS WASTE NON HAZARDOUS? XNO 7YES (if YES,stop here and sigNdate form at the bottom of page) GENERATOR'S EPA IDf1: CAL00359102 MANIFEST#:aLfj747d&dA WASTE CODE(S): 571 IS THIS WASTE RESTRICTED? &YES NO fit NO,stop here and sigMdate form at the bottom of page) THIS NOTIFICATION&CERTIFICATION IS BASED ON THE FOLLOWING WASTE STREAM INFORMATION: R(A)CHEMICAL/PHYSICAL ANALYSIS OF THE WASTE; c(B)GENERATOR KNOWLEDGE OF THE WASTE;OR 7(C)BOTH Check the appropriate boxes in Parts II and III.If only one applies,then III(A) is not required. For multiple certAicationsinoYdications,the appropriate choices from Part II(1-3)maybe marked in Part III(A)to indicate how waste is to be managed to conform with Land Disposal Restrictions. By selecting an item in Part III(A),1-3,you are making the certification/notification noted in Part II. IL TYPE OF LDR NOTIFICATION/CERTIFICATION ❑ 1.> NOTIFICATION ONLY: WASTES THAT CURRENTLY REQUIRE TREATMENT TO MEET THE 22 CCR ARTICLE 11 TREATMENT STANDARDS: 0 22 CCR§66268.7(a)(1) X- :bo54,!o 22 CCR§66268.7(a)(2) l certify underpenaltyof law that l personally have examined and am familiar with the waste through analysis and testing through knowledge of the waste to support this certification,that the waste complies with the treatment standards specified in CCR Title 22,Division 4.5,Chapter 18,Articles 4 and 11 and all app/icable prohibitions set forth in CCR Title 22,Section 66266.32 or RCRA Section 30041d)142 U.S.C.Section 6924(d)).l believe that the information/submitted is true,accurate and complete. lam aware that there are significant pens/ties for submitting a false certif6ation,including the possibility of a fine orimprisonment. 3.>NOTIFICATION&CERTIFICATION: NON-RCRA WASTE THAT HAS BEEN TREATED AT AN OFF-SITE TREATMENT FACILITY SO AS TO MEET ALL APPLICABLE 22 CCR ARTICLE 11 TREATMENT STANDARDS:�22 CCR §66268.7(b)(5) /certify under penalty of law that/persona//y have examined and am familiar with the waste through analysis and testing through knowledget of the waste to support this certification,that the waste complies with the treatment standards specified in CCR Title 12,Division 4.g,Chapter 78,Ar6clas 4 and 11 and all applicable prohibitions set forth in CCR Trt/e 22,Section 66268.32 or RCRA Section 30041d)(42 U.S.C. Section 6924(d)).l believe that the information/submitted is true,accurate and complete.l am aware that there are significant penalties for submitting a false certifrcetion,including the possibility o f a fine orimprisonone nt. III. LDR NOTIFICATION/CERTIFICATION INFORMATION REQUIRED BY 22CCR Check (A) IBI (C) IDI appropriate Check 1.2,or 3 from Corresponding boxes handling informadan Prohibition Subcategory of Restricted Waste 122 CCR 66268.29 amt and Treatment Standard I Part 11) 1:1: Date Treatability Group1a166268.100Iati144) (From 22 CCR) 1. . 1 2 ❑3 Ir26M Aqueous wastes containing metals 166268.291al&66268.1001811111 1 66268.107 Table II CCW 2. 1 2 '3 5891 Auto shredder waste 166268.291.1&66268.100(a)(3)) 2 66268.105 Table-A CCWE 3.. 1 -'2 3 1/191 Hazardous waste foundry sand l66268.29(e)&66268.100(a)1511 4 05268.105 Table 1-8 CCWE 4.X 1 2x 3 ill/91 Fly ash,bottom ash,retort ash or baghouse waste 166268.291hl&66268.100(a)(8)I 7 66268.106 Table l-D CCWE 1 2 -3 1/191 Baghousewaste from foundries 166268.29(i)&6626&1001a1I9)I 8 66280.106 Table I-E CRE 1 -2 _3 MAIM Asbestos containing waste identified in section I6826&291ml&66268.1001a111311 12 66268.114 ]. 1 2 3 Other(Spe.ify): 13 Copies of applicable treatment standards and waste analysis data(where available) are maintained at the facility identified on the manifest referenced above. IV. GENERATOR AUTHORIZATION/CERTIFICATION I hereby certify that all information submitted in this and all associated documents is true,complete,and accurate to the best of my knowledge and information,and that no omissions or errors exist.I warrant that I am an authorized representative of the generator. 1aU >7i�11r f/17 �i d7/ir A. llr4!fJt 1"17, lyr� ��vr C/ S" 5//4 Authorized Signature Printed Name Title Date THIS DOCUMENT, WITH AN ORIGINAL SIGNATURE, MUST ACCOMPANY EACH WASTE SHIPMENT. A COPY OF THIS CERTIFICATION, AND ALL SUPPORTING DATA,MUST BE RETAINED BY THE GENERATOR FOR A LEAST FIVE(5)YEARS AS PER 22 CCR§66268.7 Rev.11/02 Page_of