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SA Clean Harbors Environmental Services, Inc. California Land Disposal/Restriction Information This form is submitted in accordance with the requirements of 22 CCR 66268.7 a Ch NotifiicationMertification Form Thiso form waste codes and ( )Chapter 18 which restricts land disposal of certain hazardous wastes. The appropriate { ) 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 Format the bottom of page. Otherwise complete Part I,11,and III, and sign/date the Form at the bottom of page. (For RCRA wastes,use Clean Harbors RCRA FORMS) L GENERAL INFORMATION REGARDING GENERATOR&WASTE STREAM _ DTE Stockton LLG PHONE: 2Q9- 0-3712 SITE_2526 West Washington Street Stockton,CA.95203 PROFILE NUMBER: CH1346380 IS THIS WASTE NON HAZARDOUS? X NO YES (if YES,stop here and sign/date form at the bottom of page) GENERATOR'S EPA ID#: QAL00359102 -MANIFEST CA WASTE CODE(S): 671_ IS THIS WASTE RESTRICTED? k YES NO(rt NO,stop here and sign/date form at the bottom of page) THiS NOTIFICATION&CERTIFICATION IS BASED ON THE FOLLOWING WASTE STREAM INFORMATION: ]3(A)CHEMICAUPHYSICAL ANALYSIS OF THE WASTE; 7(13)GENERATOR KNOWLEDGE OF THE WASTE;OR =(C)BOTH Check the appropriate boxes in Parts 11 and III.If only one applies,then I II(A) is not required.For multiple certifications/notifications,the appropriate choices from Part 11(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/not]fication noted in Part 11. It. TYPE OF LDR NOTIFICATION/CERTIFICATION ❑ 1.> NOTIFICATION ONLY: WASTES THAT CURRENTLY REQUIRE TREATMENT TO MEET THE 22 CCR ARTICLE 11 TREATMENT STANDARDS:�>22 CCR§66268.7(a)(1) X �'�, =>22CCR §66268.7(a)(21 I certify underpena/tyoflaw that/personally have examinedandam 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)).I believe that the information Isubmitted is true,accurate and complete./am aware that there are significant penalties forsubmitting a false certification,including the possibility ofa fine or imprisonment. 3.>NOTIFICATION&CERTIFICATION: NON-RCRA WASTE THAT HAS BEEN TREATED AT AN OFF-SffE TREATMENT FACILITY SO AS TO MEET ALL APPLICABLE 22 CCR ARTICLE I I TREATMENT STANDARDS:>22 CCR §66266.7(b)(5) /certify under penalty of 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 78,Articles 4 and 17 and all applicable prohibitions set forth in CCR Title 22,Section 65258.32 or RCRA Section 3004(d)(42 U.S.C. Section 6924(d)).I belie ve that the information/submitted is true,accurate and complete.I am aware that there are significant penalties for submitting a false certification,including the possibility of fine or imprisonment. III.LDR NOTIFICATION/CERTIFICATION INFORMATION REQUIRED BY 22CCR Check IAy appropriate Check l,2,or3from 16l (C) IDI boxes handring Informadon Prohibition Subcategory of Restricted Wasto 122 CCR 66268.29 a-ml and Corresponding (Part 11 Effective Date Treatability Group(si,66268.100Ia1(1-14) Treatment Standard (From 22 CCRI 1._ 1 2 C3 1126190 Aqueous wastes containing metals[66268.29(al&66268.100(al l 1 66268.107 Table 11 CCW 2. 1 2 ;'3 5 8191 Auto shredder waste[66268.29(c)&66268.100Ia1{3l] 2 66268.106 Table-A CCWE 3. 71 _2 :3 111191 Hazardous waste foundry sand[66268.29(e)&66268.1001a1(511 4 56268.106 Table 1-B CCWE 4.X _1 =2X 3 1/1191 Fly ash,bottom ash,retort ash or baghouse waste 166268.294h)&66268.100(al(BI] 7 66268.106 Table l-D CCWE 2 3 1!1/91 Baghouse waste from foundries[66268.29(il&66268.1D0(a)(9)] 8 66268.106 Table I-E CWE 6.._ 1 2 3 311193 Asbestos containing waste identified in section[66268.29(ml&66268.100(a)[13)] 12 66268.114 7.7 :'1 2 3 Other(Specify): 13 Copies of applicable treatment standards and waste analysis data(where available)are maintained at the facility identified on the manifest referenced above. N. GENERATOR AUTHORIZATION/CERTIFIGATION I hereby cerlify 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. uthorized ature Prin Name T to 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§6Y OF Rev. CER Page_df