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:lean Harbors Environmental Services,Inc- California Land Disposal/Restriction Information 1�0 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 ppropriate California waste code(s)and applicable non-RCRA hazardous waste listings from CCR 66268.29 are noted below.Complete all porton of Part I. If the aste is ran-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 II,and III,and sign/date 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: 209-320-3714 SITE LOCATION:-25M W.Washington Street Stockton,CA 95203 PROFILE NUMBER (,Wj�(zi38O IS THIS WASTE NON HAZARDOUS 7 X NO YES (d YES,stop here and signidate form at the bottom of page) GENERATOR'S EPA ID#: CAL000359102 MANIFEST#:01112 f3"A-1 ECA WASTE CODE(S): 571 IS THIS WASTE RESTRICTED? X YES NO(Ir NO,stop here and sVVdate tam at the bottom of page) THIS NOTIFICATION&CERTIFICATION IS BASED ON THE FOLLOWING WASTE STREAM INFORMATION: (A)CHEMICALIPf1YsICAL ANALYSIS OF,THE WASTE; i-XB)GENERATOR KNOWLEDGE OF THE WASTE;OR iL(C)BOTH heck the appropriate boxes in Parts II and III.If only one applies.then llf(A)is rot required.For multiple certihrationslnotfintfons,the appropriate choices from Part (1-3)may be 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 111(A),1-3,you re making the certification/notification noted in Part ll. -- TYPE OF LDR NOTIFICATION I CERTIFICATION D 1.> NOTIFICATION ONLY: WASTES THAT CURRENTLY REQUIRE TREATMENT TO MEET THE 22 CCR ARTICLE 11 TREATMENT STANDARDS:a 22 CCR§66268.7(a)(1) X 2:>NOTIFICATION&CERTIFICATION:WASTE THAT MEETS THE 22 CCR ARTICLE 11 TREATMENT STANDARDS,NO ADDITIONAL TREATMENT REQUIRED:�22 CCR §66268.7(a)(2) /certify under penalty of law that/personalty 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 Tide 22,Division 4.5, Chapter 18, Articles 4 and 11 and a//applicable pmhibidons set forth in CCR Title 22, Section 66268.32 or RCRA Section 30D40142 U.S.r- Section 6924(dll. I believe that the'ulformation I submitted is tore, accurate and complete.l am aware that there am significant penalties for suiNnitting a false certification,including the possibility of a fine or imprisonment. 3.>NOTIFICATION&.CERTIFICATION: NON42CRA 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) I certify under penalty of law that/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 18, Articles 4 and 11 and all applicable prohibitions set forth in CCR rile 22, Section 66268.32 or RCRA Section 3004(47(42 U.S.C. Section 6924(d)). I believe that the information I submitted is true, accurate and complete.I am aware that there are significant penalties for submitting a false certification,including the possibility of a fine or impnsonment. 1.LDR NOTIFICATION 1 CERTIFICATION INFORMATION REQUIRED BY 22CCR Cheri (A) 161 (C) (DI appropriate Check 1.2 or 3 fran coueseeodn9 4oaas harM6n9 fo-Oon Prehbut fi otaoe of fuun tetl Wute 122 CCH 66268.29 amt and T.va ru to ndard (Pan a) Erecthm Date TreataWity Groupie)66268-100(m)(1-141 (From?2 CCRI 1. 01 32. 03 1126/90 Apmrs wastes cmlubig metffi(66]6a.29(al&68268.1001.1(1)1 1 88268.107 Table a CCW- 2.n 01 n2 113 5/8/91 Auto shedder waste(66268.29(c)6 66268.100(a1(3)1 2 66266.106 Tabwo-A CCWE 3.11 01 02 r3 1/1191 Hivardous Waste foundry sand 166268.29(4 a 66268.100(a)1511 4 66266.106 Table 1-B CCwE 4 X 01 X2 - i3 1/1/91 FW ash,bottom ash,retort ash art lusgl a aaata 16626819N 6 66268.100(x11811 7 66268.106 TWh 1-0 CCWE 5.0 0t 02 03 111191 Ba9ttouse arelte lupin luuttcidee 166268.2961&06268.100(al(911 6 66266.106 Table IE CWE 6.13 01 D2 03 3/1/93 Aabestm crsrtartwg waste iaen6flad an sectmn 166268.290,1 6 68268.100181(1311 12 66268.114 7.0 (!t 112 C3 Other ISpeuaryl: 13 Copies of applicable treatment standards and waste analysis data(where available)are maintained at the facility identified on the manifest referenced above. ✓. 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. / y -> J�IiA-?M/t1l' � ilNt-t -ilf�d71 uel (Arts can/roc/ r%b'''7G Authorized Sig tura Prilitted Name Title 1 Date NIS DOCUMENT. WITH AN ORIGINAL SIGNATURE, MUST ACCOMPANY EACH WASTE SHIPMENT. A COPY OF THIS CERTIFICATION, AND ALL IUPPORTING DATA,MUST BE RETAINED BY THE GENERATOR FOR A LEAST FIVE(5)YEARS AS PER 22 CCR§66268.7 Rev.11102 Page_of