COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

: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 ppropriate California waste code(s)and applicable non-RCRA hazardous waste listings from CCR 66268.29 are noted below.Complete all portions of Part 1. If the sste is non-hazardous or not restricted then complete only the applicable portions in Part 1 and sign I date the Form at the bottom of page. Otherwise complete Part 11,and Ill,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:-2526 W.Washington Street Stockton,CA 95203 PROFILE NUMBER VilW19 IS THIS WASTE NON HAZARDOUS? X NO :)YES (d YES,stop here and siyr✓dete form at the bottom of page) GENERATOR'S EPA IDR: CALOOD359102 MANIFEST* CA WASTE CODE(S): 571 IS THIS WASTE RESTRICTED? X VES NO(d NO,stop here and sigNdate form at the bottom of page) THIS NOTIFICATION&CERTIFICATION IS BASED ON THE FOLLOWING WASTE STREAM INFORMATION: G(A)CHEMICAL/PHYSICAL ANALYSIS OF THE WASTE; a(B)GENERATOR KNOWLEDGE OF THE WASTE;OR (C)BOTH :heck the appropriate boxes in Parts 11 and III.If only one applies,'then Ilt(A)is not required.For multiple cerlifications/nolifications,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 Rem in Part III(A), 1-3,you re making the certification/notification noted in Part IL TYPE OFLDR NOTIFICATION I CERTIFICATION r 1.> NOTIFICATION ONLY: WASTES THAT CURRENTLY REQUIRE TREATMENT TO MEET THE 22 CCR ARTICLE 11 TREATMENT STANDARDS:�22 CCR§66258.7(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) 1 certify under penalty of law that/personally have examined and am familiar with the waste through analysis and testing dlmugh knowledge of the waste to support this certification, that the waste complies ti ith the treatment standards specified in CCR Title 22,Division 4.5, Chapter 18, Articles 4 and 11 and all applicable pmhtlx'tions 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 I 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-SITE TREATMENT FACILITY SO AS TO MEET ALL APPLICABLE 22 CCR ARTICLE 11 TREATMENT STANDARDS:c 22 CCH §66268.71b)15K 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 Title 22, Section 66268.32 or RCRA Section 3004(d)(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 imprisonment. I.LOB NOTIFICATION I CERTIFICATION INFORMATION REQUIRED BY 22CCR Check IN 181 (C) 101 npprapriate Check 1,2,d 3}rear Corresponding noses handling hta nn" Protrtan n subcaregory of n<atrictee Wesae 122 CCB 66268.29 amt and Trertment Standard (Part 61 Enectiw Dam Tmalab itT c oUp(S)6628a.1o0(alll-141 Ifrom 22 CCRI 1.0 or M e3 Maim A4ueous wastes cantairvrg meals 1652611.29ral&66266.100mItl 11 1 66268.107 Tabk 11 CCW. 2.11 at 02 03 5/851 Aum shedder wrote 166268.29(c)&66268-100(Ut311 2 66266.106 Table-A CCWE 3.D 01 02 W 1/1191 HativrIMs waste foundry sari)186268.29(el&66268.100(a115n 4 66269.106 Table 1-11 C'CWE 4 X m X2 M 1/151 Fly ash,bptmm ash,niton asb ar ba those waste 166268-29N&66268.100(a)(all 7 66268.106 Table 1-0 CCWE 5.0 m 132 03 1/151 Bagtoux waste trorn toundries 166268.2918&66288.100141911 6 66266.106 TWb 1-E CWE 8.0 m W W 31153 Asbestus=muting waste klendtied an snctlen 166266.29(rN 6 66266.10001413)1 12 66266.114 7.0 Ot 02 Rd Other lspeciNi: 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 AUTHORRATIONICERTIFICATION 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 eldst I warrant that I am an authorized representative of the generator Authorized Si ature( Printed Aame late Date -HIS DOCUMENT, WITH AN ORIGINAL SIGNATURE, MUST ACCOMPANY EACH WASTE SHIPMENT. A COPY OF THIS CERTIFICATION, AND ALL ;UPPORTING DATA,MUST BE RETAINED BY THE GENERATOR FOR A LEAST FIVE(5)YEARS AS PER 22 CCR§66268.7 Rev. 11102 Page-of