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C :lean Harbors Environmental Services, Inc. California Land Disposal/Restriction Information Notification/Certification Form his form is submitted in accordance with fine requirements of 22 CCR 662687(a) Chapter 18 which restricts land disposal of certain hazardous wastes. The Crimmins,California waste code(s)and applicable non-RCRA hazardous waste listings from CCR 66266.29 are noted below.Complete all porters of Pan I. If the aste is non-hazarcbus or not restricted then Complete only the applicable portions in Pan I and sign/date the Form at the bottom of page. Otherwise complete Part II,and III,and signAdate the Form at 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: 209320-3714 SITE LOCATION_2526 W.Washington Street Stockton.CA 95203 PROFILE NUMBER. CH641753B IS THIS WASTE NONHAZARDOUS? XNO -:YES (if YES,stop here and sign/date form at the bottom ofpage) GENERATOR'SEPAID#: CAL000359102 MANIFEST*ddgj�0/jjna CA WASTE CODE(S): 571 IS THIS WASTE RESTRICTED? XYES NO f#NO,stop here and sgNdate/ono at the bottom ofpage) THIS NOTIFICATION&CERTIFICATION IS BASED ON THE FOLLOWING WASTE STREAM INFORMATION: (A)CHEMICAUPHYSICAL ANALYSIS OF THE WASTE; .:(B)GENERATOR KNOWLEDGE OFTHE WASTE',OR i;(C)BOTH :heck the appropriate boxes in Paris II and 11 If only one applies,then II I(A)is not required.For multiple certicationslnollfioations,the appropriate choices from Pan (1-3)maybe marked in Part III(A)to indicate how waste is to be managed to conform with Land Disposal Restfictions. By selecting an item in Pan III(A), 13,you ne making the cerificz60n I notification noted in Part II. TYPE OF LDR NOTIFICATION/CERTIFICATION 1.> NOTIFICATION ONLY: WASTES THAT CURRENTLY REQUIRE TREATMENT TO MEET THE 22 CCR ARTICLE II TREATMENT STANDARDS:0 22 CCR§66268.7(a)(1) X 2. r NOTIFICATION&CERTIFICATION:WASTE THAT MEETS THE 22 CCR ARTICLE 11 TREATMENT STANDARDS,NO ADDITIONAL TREATMENT REQUIRED:0 22 CCR 466260.71,1(2) l certify underpenally of law that/personally have examined and am familiar with the waste thmugh analysis and testing through knowledge of the waste to support this certihcation, that the waste complies with the treatment standards specified in CCR Title 22,Division 4.5, Chapter 18, Articles 4 and I r and al/applicable prohibitions set forth m CCR Title 22, Section 66268.32 or RCRA Section 3004(dl(42 U.S.C. Section 6924(dlb I believe that the'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. 3.,NOTIFICATION&CERTIFICATION: NON-RCRA WASTE THAT HAS BEEN TREATED AT AN OFF-SME TREATMENT FACILITY SO AS TO MEET ALL APPLICABLE 22 CCR ARTICLE 11 TREATMENT STANDARDS:>22 COB 466268.71b1(5) /certify under penalty of law that I persona//y have examined and am familiar with the waste through analysis and testing through knowledge of Me waste to support this certification, that the waste complies with the treatment standards specified in CCR Title 22,Division 4.6, Chapter 18, Articles 4 and 11 and all applicable prohibitions set forth in CCR Title 22, Section 66266.32 or RCRA Section 300417/1(42 U.S.C. Section 6924(d)l.l believe that the 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 Check IAI On ICI Irl appropriate Check 1.2.or 3 Flom Commmmi mass handles nlwmNon Pm1,Ibilion pmeme9ory o1 Reeblcled worm 123 Co.af.a,29—1-al rommem parcels (Pan In Vision a Ines Trce[ackay coupon 66268.100(a11P 14) IF,em 22 CCM 1. '1 :.1 :3 I/2&90 Anueoua whose containing home all2anatkh&66208.1oomIllll I 662fi0.102 Table 11 CCW 2.- `I "2 '3 seog, Ano shredder wane I66M8.2bel&66268.1001a11311 2 88268.106 Table-A CCWE A lit ^3 "list Ileaamous arms bundlI and 186269391,1 8 68268.1001811511 6 66268.106 Table I B CCWE a% 1 %2 .3 I/I/at FlY ran,hmorm an,me—mror te0l[ouse hem IsCin.29rn1866266.1oonnol 7 66268.106 Table I D CCM 5..! PI l:2 :l3 1/1191 fashouse wrote nomfmndrle¢166268.2961&66268,u)(nall911 0 66288.106 Table 1,1 CWE a '1 02 3/1/W Aabea[o¢wn[aininp wash idemiliN in asction{88268.39(m)866288.1W1a11131 t2 662fi0.1 is 7. 1 Z2 '3 comer ble-ilyb 13 Copies of applicable treatment standards and waste analysis data(where available)are maintained of the facility identified on the manifest referenced above. J. GENERATOR AUTHORIZATIONICERTIFICATION 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. I U rA�! A,rlfi�en/9 ..�0'4r/ M /ZIP/fAal_�uo[vy✓,.ser ��a—� Authorized Sigiatuor Pnnteh Name Title Date HIS DOCUMENT, WITH AN ORIGINAL SIGNATURE, MUST ACCOMPANY EACH WASTE SHIPMENT. A COPY OF THIS CERTIFICATION, AND ALL a IPPnRTINC.DATA MUST BE RETAINED BY THE GENERATOR FOR A LEAST FIVE(5)YEARS AS PER 22 CCR§66268]Rev.11/02 Page_of