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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 Form at the bottom of page. Otherwise complete Part 1, 11, and III, and sign/date the Form at the bottom of page. (For RCRA wastes,use Clean Harbors RCRA FORMS) 1. GENERAL INFORMATION REGARDING GENERATOR&WASTE STREAM DTE Stockton LLC PHONE:_2921212712--SITE_2526 West Washington Street Stockton,CA 95203 PROFILE NUMBER: CH1346380 IS THIS WASTE NON HAZARDOUS? X NO ❑YES (d YES,stop here and sign/date form at the bottom of page) GENERATOR'SEPAID#: CAL00359102 MANIFEST #OffsP397SFCf �:CA WASTE CODE(S): 571 IS THIS WASTE RESTRICTED? yc YES NO(d NO,stop here and sigNdate form at the bottom of page) THIS NOTIFICATION&CERTIFICATION IS BASED ON THE FOLLOWING WASTE STREAM INFORMATION: K(A)CHEMICAL/PHYSICAL ANALYSIS OF THE WASTE; (B)GENERATOR KNOWLEDGE OF THE WASTE;OR (C)BOTH Check the appropriate boxes in Parts II and 111.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 It. Il. TYPE OF LDR NOTIFICATION/CERTIFICATION ❑ 1.> NOTIFICATION ONLY: WASTES THAT CURRENTLY REQUIRE TREATMENT TO MEET THE 71 CCR ARTICLE 11 TREATMENT STANDARDS:X22 CCR§66268.7(a)(1) X :«'b mb 22 CCR§66268.7(a)(2) /certify underpenalty of law that t 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 specif/ed in CCR Title 22,Division 4.5,Chapter 18,Articles 4 and 11 and all applicable prohibitions set forth in CCR Title 22,Section 66268.32 or RCRA Section 3004td)(42 U.S.C. Section 6924(d)).l believe that the information t submirted is true,accurate and complete./am aware that there are significant penalties for submitting a fa/se certification,including the possibility of 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 peva/tyof 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 treatmentstandards specified in CCR Title 22,Division 4.5,Chapter 18,Articles 4 and 11 and alt applicable prohibitions set forth in CCR Title 22,Section 6626832 or RCRA Section 3004(d)(42 U.S.C. Section 6924(d))./believe that the information/submitted is true,accurate and complete./am aware that there are significant penalties for submitting a false cefttficetion,including the possibility ofa fine or imprisonment. III.LDR NOTIFICATION/CERTIFICATION INFORMATION REQUIRED BY 22CCR check (A) =D.wTmmbifi�ty IDIayP..... Geek 1.2,or 3 from bhandling information y of Restricted Wastes(22 CCB 6626829 am)and comes(Part 11) Groupie)6626&100(al(1-14) Treatment Stantlard )From 22 CCB) 1' '1 2 '33 1/2650 Aqueous wastes containing metals[66268.29(a)&66268.100(a)(111 1 66266.107 Table 11 CCW 2. =1 2 '3 5/8191 Auto Shredder waste 166268.29(c)&66266.100fa011 2 66266.106 TabIaA CCWE =2 -3 1/1191 Hazardous waste foundry sand 166268.29(a)&6626111W(a115)I _ 4 66268.106 Table l-B CCWE FX1 2X 3 1/1191 Fly ash,boom ash,relort ash or baghousewaste 166268.29(h)&66268.100(3)1811 7 66268.106 Table I-D CCWE 2 C3 1/1191 Baghousewaste from foundries[66268.290)&66268.100(a)(9IIB 68268.106 Table l-E CWE Z1 72 3/1/93 Asbestos mntaining waste idandfied in section 166268.29(m)&66268.1001a1(13)l 12 06268.114 -q -23 Other r3pecifyl: 13 LL pplicable treatment standards and waste analysis data(where available)are maintained at the facility identrfied on the manifest referenced above. IV. GENERATOR FIT IC 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 repr_ese/ntaen of the generator. rwmonzeD S�nature/ �"�"" ,, X- '�"r�'l! !!1 Printed Name Title Date THIS DOCUMENT, WITH AN ORIGINAL SIGNATURE, MUSTACCOMPANY FACH 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