COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

Clean Harbors"Irivlronmental Services, Inc. California Land Disposal/Restriction Information Notifi'catioNCertification Form this 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 appropriate 7al'Ifomia waste codes)and applicable non-RCRA hazardous waste listings from CCR 66268.29 are noted below.Complete all portions of Part L If the waste is non- lazaro'ous 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 I, 11,and III, and signidate the Form at the bottom of page. (For RCRA wastes,use Clean Harbors RCRA FORMS) . GENERAL INFORMATION REGARDING GENERATOR&WASTE STREAM DTE Stockton LLC -PHONE: 209320-3712 SITE_2526 West Washington Street Stockton,CA.95203 PROFILE NUMBER: CH6417538 ISTHISWASTENON HAZARDOUS? XNO _ YES ('AYES,stop here and sign/date form at the bottom of page) GENERATOR'S EPA IDB: CAL00359102 MANIFEST H:96/4 3 C WASTE CODE(S): 571 IS THIS WASTE RESTRICTED? z YES NO(ANO,stop here and sign/date form at the bottom of page) THIS NOTIFICATION&CERTIFICATION IS BASED ON THE FOLLOWING WASTE STREAM INFORMATION: R(A)CHEMICAL/PHYSICAL ANALYSIS OF THE WASTE; -(B)GENERATOR KNOWLEDGE OF THE WASTE;OR =(C)BOTH heck the appropriate boxes in Parts II and III.If only one applies,then III(A) is not required.For mulfiple certifications/notifications,the appropriate choices from Part 1(1-3)maybe 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 HI(A),1-3,you are Waking the certification/notification noted in Part II. 'I. TYPE OF LDR NOTIFICATION/CERTIFICATION ❑ 1.> NOTIFICATION ONLY: WASTES THAT CURRENTLY REQUIRE TREATMENT TO MEET THE 22 CCR ARTICLE 11 TREATMENT STANDARDS:X22 CCR§66268.7(6)(1) X mb:«vim 22 CCR§66268.7(a)(2) /certify under penalty of law that tpersonally have examined and am familiar with tha waste through analysis and testing through know/edge 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 orRCRA Section 3004(d)(42 U.S.C. Section 6924(d))./believe that the information/submitted is true,accurate and complete.l am aware that there are significant penalties for submitting a false certification,including the possibility of 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:�22 CCR §66268.7(b)(5) /certify underpena/ry of law that/persona//y 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 6626832 or RCRA Section 3004(d)142 U.S.0 Section 6924(d)).l believe that the information/submitted is true,accurate and complete.l am aware that there are significant pena/ties forsubmitting + a false certification,including the possibility of fine or imprisonment. III.LDR NOTIFICATION/CERTIFICATION INFORMATION REQUIRED BY 22CCR Check (A) 181 ICI IDI appropriate Check 1,2,or 3 from boxes handling information Prohbi6on subcategory of Restricted waste(22 CCR 66268.28 ern)and Cement Sta d (Part 111 Effective Date Treatability Grcuph166268.100(s)(1-161 Treatmantetantlard E.nd 22 CCR) 1' 1 2 3 1,26/90 Aqueous wastes containing metals 166268.29(6)&66268.1wfa;1111 1 66268.102 Table 11 CCW 2. 7 2 3 6&91 Auto shredder waste166268297.)&66268.1001.011 2 66268.10fi Tab le-A CC 3. -1 -2 3 111.91 Hazardouswasle foundry sand 166268.29(e)&66268.1 Walb)l 4 662iSSID6Table l-B CCwE 4.X 1 x2 3 1:191 Fly ash,bottom ash,relort ash or baghouse waste 166268.29ib1&66268.1W(ai!Sli ] 66268.106 Table t-0CCWE 8-- _1 2 3 vb91 Baghousewaste from foundries i66268.29(i)&66268.1001a)(9)) 8 66268.106 Table l-E CWE 6.-: '.1 2 -3 3:193 Asbestos mmaining waste identified in section l66268.291m)&66268.10[4.0311 12 66268.114 Z- 1 2 '3 Other7Spardyl: 13 Copies of applicable treatment standards and waste analysis data(where available) are maintained at the facility identified on the manifest referenced above. IV. GENERATOR AUTHORIZATION/CERTIFICATION 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 thatnoorr errors e>ast�.I warrant that I am an authorized representative of the generator. igki� J/Ll r rte//dsyl ��}2ydJlvi /r Lr c Authorized S alure Printed Name TRIe Date THIS DOCUMENT, WITH AN ORIGINAL SIGNATURE, MUST ACCOMPANY EACH WASTE SHIPMENT. A COPY OF THIS CERTIFICATION, AND ALL SUPPORTING DATA,MUST BE RETAINED BY THE GENERATOR FOR A LEAST FIVE(5)YEARS AS PER 22 CCR§66268.7 Rev. 11 i02 Page—of