|
,lean Harbors Environmental Services,Inc. Caftrnia Land DisposallResthction Information
<br /> Natificativn/CoMficatbon Farm
<br /> his"Orr is submitted in accordance with the requirements of 22 CCR 66268.7{a)Chapter 1 awhich restricts land ft'
<br /> Dosal of certain hazardous wastes.The appropriate
<br /> :alifomia waste code(s)and applicable non-RCRA hazardous waste from CCR 66266.29 are noted below.Complete ail pomons of Part 1. ff the waste is non-
<br /> azardous or not restricted then complete only the awe porgorm in Parl I and sign l date the Form at the bottom of page. Otherwise Conplete Part 1,11,and III,
<br /> nd sign,`date the Form atthe bottom of page.(For RCRA wages,use Clean Harbors RCRA FORMS)
<br /> GENERAL INFORMATION REGARDING GENERATOR&WASTE STREAM s
<br /> DTE-Stockton.-LLC PHONE 20932[13712SITE 2526 West Washi Street 5todctalT,GA 952113
<br /> IRGFILE NUMBER: CH6417538 IS THIS WASTE NON HAZARDOUS? X NO w YES
<br /> (if YFS,srup here and signfdafe form at ft boffam of page)
<br /> GENERATOR'S EPA! : CAL00359t02 MANIFEST p;p/[17177CA WASTE CODE(S): 5711 IS THIS WASTE RESTRICTED? R YES
<br /> IJ 0 IV NO,stop here and siyrtldate form at litre bottom of page)
<br /> i HIS NOTIFICATION&CERTIFICATION IS BASED ON THE FOLLOWING WASTE STREAM INFORMATION:
<br /> (AI CHEMICAUPHYSICAL ANALYSIS OF THE WASTE; -(B)GENERATOR KNOWLEDGE OF THE WASTE;OR (C)BOTH
<br /> :heck the appropriate bones in Parts 11 and Ill.If ordy one applies,then III(A)is not reed.For multiple ,the appropriate choices from Part
<br /> (t.3)may be marked in Part(fl(A)to R*tate how waste is to be managed to conform Y&Land Disposal Reshidiors� By selecting air item in Part III(A),1-3,you are
<br /> laking the oer0fication I notification noted in Pat 11.
<br /> TYPE OF LDR INOTIFICTION I CERTFICATION
<br /> ,j 1.> NOTIFICATION ONLY; WASTES THAT CURRENTLY REQUIRE TREATMENT TO MEET THE 22 CCA ARTICLE ii TREATMENT
<br /> STANDARDS:=;�22 CCR§6e2M7(a)(1)
<br /> s�
<br /> X � 22 CCR§66268.7(a)12)
<br /> i ceefify underpenalty of lave that l personaW have examined and am familiar with the baste through analysis and testing through knowiedgd
<br /> of the waste to support this ramification,that the waste complies widr bre Treatment standaids specified in CCR Title 22,f?ivision 4.5, Chapter
<br /> 18,Arrides 4 and I I and all applicable prohibitions set forth in CCR Title 2z,Section 6&2683?orRC174 Section 3W4(d)(42 U.S G Section
<br /> 6924(d)).l believe that the information l submined&true,accurate and complete 1 am awam that there are signdlicant penalties forsubmittimy
<br /> B false certifrt-8110n,incl►,ading the possibility ofa fine or imprisonment
<br /> 3.>NOTIFICATION&IERTTtFWATKNW. ANON-RCRA WASTE THAT HAS BEEN TREATED AT AN OFF-SITE TREATMENT FACILITY SO AS TO
<br /> MEET ALL APPLICABLE 22 OCR ARTICLE 11 TREATMENT STANDARDS a 22 CCR 56SM7(b)(51
<br /> I certify underpewftyof law that 1 personally have earamined and am familiar with the"str through analysis and&-sdrg through knomfedge
<br /> of the waste to support this cerrigcation,that the waste complies with the treafffmat standar fs specified in CCR TWO 22,Division 45,Chaprer
<br /> 14 Arfiores 4 and 11 aril allapyraticabk prohibitions set forth in CCR Title 22,Section 66Ma?orRCRA Section 3A04fd)(42 U.S.C. Section ,
<br /> 6924/d)).4 believe that the infom-wtion I subnr hied is true,accurala and comp/OM 13m awam that there are significant penaAties for Submitting
<br /> a false cei frcation,including the possibility ofa Fme or impnisonment
<br /> R.LOO NOTIRCATION t CERTIFICATION 1NtFORIKATION REQLMM BY 220CR
<br /> Check JAI (8) ICI Enl
<br /> aptrropri— Che,*1,2,a 3 f1—. CORes onenn7o
<br /> baxw hatKwmg hft"Offo n Prihadfim SabCshpgpry d Ra mrkled Waste t22 CCA &-al bed Treaenent Standard
<br /> (Partin Elie cdwDate Tr wUMMOyGrouplal6626LIWaH1-141 (Froze 22 CCrii
<br /> 1 -2 3 1.+2m Aqueauawastescorr Ting metets[£e26$.29tai&W28&1r1t)ra il7jI t 66258.Tu7 Tahra�CCW
<br /> Z. _:1 :-.I 3 61481 Aute thradderwamo Tt+OG9-21)(416651e&100ta1131T s 6a2ee_106 Table-A CONE
<br /> 3. 1 2 3 1154 Hezardauswasts laundry sand'6626&2E 4&5526MMahbili 4 M26BAM Table 1-6 CUIPE
<br /> 4.1, 1 1 :.3 131$.11 Fly ash,bottom ash,retort ash ar baghoaSewaswJ68 E.2,90)&66M.106fairWj 7 5625f i06 Table t-0 CME
<br /> 1111 Eaghouse wawa tram twndrim i6626E.29w&S62S9 iMaIMI 0 662MY06 Table i-E GYNE
<br /> tL -1 -2 A 3'4,83 Arbestm ooroirang waste identified in sin[ .2!Nm?A MaMlWali 1311 12 562%1 T4
<br /> 7, 1 .:2 -3 omerlspenfyl: 13
<br /> Copies of applicable treatment standards and waste anaSysis data(where available)are maintained at the isAfty idenfified on the manifest referenced above.
<br /> N. GENERATOR ACITHORIZATI(3NMERTIF-iCATION
<br /> I hereby certify that all information subrn tted in this and all associated documents is true,complete,and acclrrale to the best of my knowledge and information,and
<br /> that rT0 omissions or arrays eras[.1 wwrM 1t0!am an atltttorrced t1 Sresentaliue of the gerTeratrx_
<br /> Authorized - atae printed a TdHe Data
<br /> THIS DOCUMENT, WITH AN ORIGINAL SIGNATURE, MUST At,('AMPANY EACH WASTE MPMEN T. A COPY OF THIS CERTIFICATION, AND ALL
<br /> SUPPORTING DATA,MUST BE RETAINED BY THE GENERATOR FOR A LEAST FIVE(5)YEARS AS PEA 22 CCR$66266.7 Rev.1 IM2 Page ^Ot
<br />
|