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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(a)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 Forth at the bottom of page. Otherwise complete Part I, ll,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: 209-3213712 SITE_2526 West Washington Street Stockton,CA.95203 PROFILE NUMBER: _QH1346380 IS THIS WASTE NON HAZARDOUS? X NO -YES (d YES,stop here and sigNdate tone at the bottom of page) GENERATOR'S EPA ID#: CALOD359102 MANIFEST H:&15B397/`GE CA WASTE CODE(S):_571 IS THIS WASTE RESTRICTED? X YES NO(6 NO,stop here and sign/dwe form at the bottom of page) THIS NOTIFICATION&CERTIFICATION IS BASED ON THE FOLLOWING WASTE STREAM INFORMATION: X(A)CHEMICAUPHYSICAL ANALYSIS OF THE WASTE; -(B)GENERATOR KNOWLEDGE OF THE WASTE;OR _ (C)BOTH Check the appropriate boxes in Parts 11 and III.If only one applies,then III(A) is not required.For multiple certifications/notifications,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 If. IL TYPE OF LDR NOTIFICATION/CERTIFICATION ❑ 1.> NOTIFICATION ONLY: WASTES THAT CURRENTLY REQUIRE TREATMENT TO MEET THE 22 CCR ARTICLE 11 TREATMENT STANDARDS:X22 CCR§66268.7(a)(1) X �mD f'? 22 CCR§66266.7(a)(2) /certify under penalty of law that/persona//y 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,Anic/es 4 anc(71 and all applicable prohibitions set forth in CCR Title 22,Section 66268.32 or RCRA Section 3004id)f42 U.S C. Section 6924(d)).l believe that the information/submitted is troe,accurate and complete.l am aware that theca are significant penalties for submitting a false certification,including the possibility of a fine or imprisonment. 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:a 22 CCR §66268.7(b)(5) /certify under penalty of law that l personal/y 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 71 and all applicable prohibitions set forth in CCR Title 22,Section 66268.32 or RCRA Section 3004(d)(42 U.S.C.Section 6924(d))./believe that the information l submitted fs true,accurate and complete.lam aware that there are significant penalties forsubmitting a fa/se cenification,including the possibility ofa fine orimprisonment. III.LDR NOTIFICATION/CERTIFICATION INFORMATION REQUIRED BY 22CCR Check (A) IBI appropriate Check 1.2,or 3 from ICI IDI boxes handling information Prohibition Subcstagory of Restricted Waste 122 CCR 66288.29 aml andTreatment Standard Corresponding (Pan III EHtxtive Date Treatability Group(a)ri6268.100(ap1-14) (From 22 CCBI LL 1 L'2 V26/90 Aqueous wastes containing metals[66268.291a1&66268.1001a1(111 1 66268.107 Table II CCW 2. 1 -2 -.3 5/891 Auto shredder waste 166268.29(c)&66268.100(a)(311 2 66268.106 Table-A CCWE 3._. 1 -2 _3 1/191 Hazardous waste foundry sand 166268.291el&66268.1001a11511 / 66268.106 Table 1-B CCM 4.X 1 1X 3 1/191 Fly ash,bottom ash,retort ash or baghouse waste 166268.29(h)&66268.100(a)18) ] 66268.106 Table I-D CCWE 5. 1 2 3 11191 Baghouse waste from foundnes 166268.29(i)&66268.100(el(911 8 66268.106 Table l{CWE 6. - 1 -2 3 3/193 Asbestos containing waste identified in section[fi6268.291m1&66268.1001a111311 12 66268.114 ]' 1 -2 3 Other(Spedty): 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 eerirfythat 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 a errors exist.I warrant that I am an authorized representative of the generator. 7/Z 1rF,f_eisr�7 6yl? JJlil A loLv1[!7 � /�t� . � r r 4 Authorized aNre Primed Name TRIe 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 DV'_ Z(4