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:lean Harbors Environmental Services, Inc. California Land Disposal/Restriction Information Notification/Certification Form his 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 Dpropnses California Waste cotle(s)and applicable non-RCRA hazardous waste listings from CCR 66268.29 are noted below. Complete all portions of Par[I. If the aste is non-haaseci or not esMcted then complete only the applicable portions in Pad I and sign I date the Farm at the bottom of page. Otherwise complete Part It.and III,and sign/dale 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: 209-3203714 SITE LOCATION, 2526 W.Washington Street Stockton,CA 95203 PROFILE NUMBER. CHU1753B IS THIS WASTE NON HAZARDOUS? XNO YES (A YES,stop here and sgNdate/arm at the bottom ofpage) GENERATOR'S EPA DO: CAL000359102 MANIFEST#:DJJOI0 00 a CA WASTE CODE(S): 571 IS THIS WASTE RESTRICTED? X YES NO(if NO.stop here and sigNdate form of the bottom ofpage) THIS NOTIFICATION&CERTIFICATION IS BASED ON THE FOLLOWING WASTE STREAM INFORMATION: (A)CHEMICAUPHYSICAL'ANALYSIS OF THE WASTE', (B)GENERATOR KNOWLEDGE OF THE WASTE;OR -.(C)BOTH :heck the appropriate bores in Parts 11 and III.If only one applies.then VIA)is not required.For multiple cetifcationslnolifications,the appropriate choices from Part (1-3)may be marked in Pan III(A)to indicate how waste is to be managed to confo ret with Land Disposal Restrictions. By selecting an item in Pan III(A), 1-3,you has making the cedification/metrication noted in Part 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 2;>NOTIFICATION 8t CERTIFICATION:WASTE THAT MEETS THE 22 CCR ARTICLE 11 TREATMENT STANDARDS.NO ADDITIONAL TREATMENT REQUIRED:0 22 CCR §662683(6)12) l certify underpenalty of law that 1 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 CCF 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 30041.1)(42 U.S.C. Section e 6924(d)).l believe that the information I submitted is toe,accurate and complete.l are 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-SRE TREATMENT FACILITY$O AS TO MEET ALL APPLICABLE 22 CCR ARTICLE 11 TREATMENT STANDARDS:0 22 CCR §66268.71b1151 /comfy underpenalty 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 compound standards specified in CCR Title 22,Division 4.5, Chapter 18, Articles 4 and f I and ell apptherble prohibitions set forth in CCR Tale 22, Section 66268.32 or RCRA Section 3004Id1142 U.S.C. Section 6924(.1)). /believe that the information I submitted is toe, accurate and complete./am aware that there are significant penalties for submitting a false certification,including the possibility of a fine or imprisonment. 1.LDR NOTIFICATION I CERTIFICATION INFORMATION REQUIRED BY 22CCR cbeh hot on ICI tot Cri L2,o,31rom eonessamben9 eob mIn ea names.,br1mme(on emanation Subcategory al Restated Waste 122 CCR 66268,29.an and Treatment Somalia (Partl6 EllecfWe aorta Timberline,G,oup10I 66268.1001101 IFmm 221 ] 3 ll2asa AOueous waseea containing metals 166268.29(a)&66268.1001afl 11 1 66268.107 Table II CCW Lr "I 1 .3 b.191 see 16626029fd&......assistant 2 66288.106 Table A CCwe C2 3 I/1/91 Xamrdous w ew ri be 166268.291.1&66268.1.1a11811 4 69266.106 Table 1 8 CCWE 4% M %2 .3 VVIn Fly esn,boom est,renin asn b,been...b ar ere uO298.294rt&66266.1O in)(f 11 7 66268,106 Table 1 D CME 5. . [It u2 .13 111/91 Ba9bouse warm loco laundries 1662683911)&66268.1001611911 8 66261.106 Table l-E CWE 6. Sl D2 3 thibe PsbeAot Cbne.inina waste lhoolied in section 166268.291ml&99286. lthanall 12 IONI 114 7 "1 "3 '3 1 Other l9peedi 13 Copies of applicable treatment standards and waste analysis data(where available)are maintained at the facility identified on the manifest referenced above. J. GENERATORAUTHORIZATION/CERTIFICATION I hereby canny that all intonation submitted in this and all associated documents is true,complete,and accurate to the best of my knowledge and information,and that no om" sio s cr errors ext 1.I warrant that 1 aman sublimed representative of the generator. /rn� AllrY/1e O .rLFy/? "i fA��nJi,Ser ywal e) Authorized Si to P' Name Tale Data :HIS DOCUMENT, WITH AN ORIGINAL SIGNATURE, MUST ACCOMPANY EACH WASTE SHIPMENT. A COPY OF THIS CERTIFICATION. AND ALL a IPPORTING DATA.MUST BE RETAINED BY THE GENERATOR FOR A LEAST FIVE(5)YEARS AS PER 22 CCR§66268.7 Rev. 11/02 Page_of