COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

A :lean Harbors Environmental Services, Inc. California Land Disposal/Restriction Information Notification/Certification Form his fan is submitted in accordance with the requirements of 22 CCR 66268.7(a) Chapter 18 which restricts land disposal of ceding hazardous wastes. The opropmee Calbornia waste code(aj and applicable non-RCRA hazardous waste listings from CCR 66268.29 are noted below Complete all podior s of Pall I. If the asle is noir-hazardous or not restricted then Complete only the applicable porting in Part I and sign I date the Farm at the bottom of page. Otherwise complete Part 11,and III,and sigNdate the Form W the bottom of page.(For RCRA wastes,use Clean Harbors RCRA FORMS) GENERAL INFORMATION REGARDING GENERATOR&WASTE STREAM GENERATOR'S NAME DTE Stockton LLC PHONE: 209.720-3714 SITE LOCATION: 2526 W.Washington Street Stockton,CA 95203 PROFILE NUMBER: CHU17538 IS THIS WASTE NON HAZARDOUS? XNO .;YES (if YES, step here andsggldate/arm at the bottom ofpage) GENERATOR'S EPA IDk: CAL000359102 MANIFEST p:Q/(SA✓dx3C& CAWASTECODE(S): 571 IS THIS WASTE RESTRICTED? RYES NO(if NO,stop here antl signmale format the bottom ofpage) THIS NOTIFICATION&CERTIFICATION IS BASED ON THE FOLLOWING WASTE STREAM INFORMATION: (A)CHEMICALIPHYSICAL'ANALYSIS OFTHE WASTE; ..-$B)GENERATOR KNOWLEDGE OF THE WASTE;OR _.(C)BOTH :heck the appropriate bakes in Parts II and III.If only one applies,then IIIA)is not required.For multiple cedficationstnolifications.the appropriate choices from Pen (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 Rem in Part III(A),1-3,you re making the certification/notification noted in Part II. 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(x)(1) X 2.>NOTIFICATION&CERTIFICATION:WASTE THAT MEETS THE 22 CCR ARTICLE 11 TREATMENT STANDARDS,NO ADDITIONAL TREATMENT REQUIREO:>22 CCR 466268.7(.)(2) 1 canary under penalty o/law that/personally have examined end am familiar with the to through analysis and testing through knowledge of the to to support this certificatten, that the mile complies with the treatment standards specified in CCR Tick 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 30041d)142 U.S.C. Section 6924401.1 believe that the information I submitted is code,accurate and complete.l an aware that there are significant penalties far submitting a false seni non,including the possibility of a fine or tmpfisanmenr. ` 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:0 22 CCR 466268.7(6)(5) J I certify under penalty of law that I personally have examined end 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 applicable prohibitions set forth in CCR Title 22, Section 66268.32 or RCRA Section 30041d)(42 U.S.C. Section 6924141). /believe(hat do,information/submitted is true,accurate and complete. /am aware that there are significant penalties for submitting a false certification,including the possibility of a fine or imprisonment. I.LDR NOTIFICATION/CERTIFICATION INFORMATION REQUIRED BY 22CCR CnecY 00 at (cl IDI appoiakin. Cl,eh 1.2.or.bvm 0orrnr..Elnp boaaa radar nl[,nueon RoMbnion Sv .only of keiknnM W...R2 CCR sates.a.ml aria Tnatr-m Sui.d.ra IPort 111 E11e[Me Dne TreetisMay Gmupol 66268.1o01e111141 them 22 CCa1 L- Q 13 1126/90 Acro-ni metas[ niiii„a morale 1652M.291a)&662641AMia11111 1 66268.107 Table 11 CCW 2. -3 23 6/091 Aum-hoods,wane 16626&2.1tl 6 66260.1 (inll311 2 66286.106 Tab10-A COWS a.- ]I 32 113 11191 xamoua—11.munny sand[.else-2e10&6.2ea.l 0alen511 0 86269.106 Table 1 0 CCWE a k ]1 %2 ::3 111191 Fly o0,.1orn¢s0.tion into o,bapbouse wad 16626&2all S 66206.1001.11811 7 66266.106 Teale bD CME 6. Cl ] a3 1/1/91 aniih—wastek—hundriee 166269.29111&66268.10cul(911 8 66286.106 Table 4E CWE 02 -3 3/1/83 Aabesao[[onlelNnp wawa Mertul.idin.N.n 166268.291 m1&66268.100 1 a 111311 12 66280.114 7. _1 7i2 C3 iiia,(ift-iN): 13 Copies of applicable treatment standards and waste analysis data(where available)are maintained at the facility identified on the manifest referenced above. J. GENERATOR AUTHORIZATION/CERTIFICATION I hereby certify that all information submitted in this and all assocrated documents is true,complete,and accurate to the best of my knowledge and information,and that no omissions Or ants aA.t.I warrant that I am an authorized representational of the generator. 4zrP(aq �l�dMO A+f�incf JO/9AIStY`I f2fP�fa� Authorized Si atu Print Name �Tltle Date HIS DOCUMENT, WITH AN ORIGINAL SIGNATURE, MUST ACCOMPANY EACH WASTE SHIPMENT. A COPY OF THIS CERTIFICATION. AND ALL B IPPORTINC.DATA MUST BE RETAINED BY THE GENERATOR FOR A LEAST FIVE(5)YEARS AS PER 22 CCR§66268.7 Rev.11102 Page_of