COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

:lean Harbors Environmental Services,Inc. California Land DisposaVRestriction Information NotifltationiCertiflcation Form fhisfcrm issubmitted in acGadancewft the requirements of 22 CCR 6626a.7(a)Chapter 18 which restricts land ftpmai of certain hazardous wastes. The appropriate ,alifot n is waste codes)and applicable non-RCRA hazardous waste listings from CCR 66258.28 are noted below.Complete mplete gal portions of Part I. kf the waste is non iarerclov,q or.not restrict W then complete only the&ppli[atile portions In tat I and sip/date the Form at the boWn of page. Otherwise complete Part 1,11.and lir, and sign/date the Form at the bottom of page.(Far RCRA wastes.use Clears Harbors RCRA FORUMS) i. GENERAL INFORMATION REGARDING GENERATOR&WASTE STREAM DTE SWdd–n.LLCPHONE:,209.320-3712._SfrE_2526 West Washlr Street Stockton,CA-952053 PI10FILE NUMBEFL 1 T IS THIS WASTE NON HAZARDOUS? X NO YES (I YES,stop two and sigrAble lnrm at titre boWn of page) GENERATORS EPA IDN: G6LfA359102 __ MANIFEST Pf;Q��.ebA WASTE COOE(S'):57f__IS THIS WASTE RESTRICTED? t<YES NO(if NO,stop here and SVI(date form at tW bo[On Of page) F T-iIS NOTIFICATION&CERTIFICATION IS BASED ON THE FOLLOWING WASTE STREAM INFORMAT11ON_ Ir(A)CHEMICAVPHYSICAL ANALYSIS OF THE WASTE; -(E)GENERATOR KNOWLEDGE OF THE Wx3TE;OR _(C)BOTH Check the appropriate boxes in Parts It and Ili.if only one applies,then-111J-A) is not reqTZe"d–F—armulliple cerftaoxWinotiketions,the appropriate choices from Pad 11(1-1S)may be marked In Part IRA)to intftcate trove waste is to be rnanaged to c ordorm wkh Land Disposab Bea" By selecting an item in Part Ikl(A),1-3,You are makbig tie certification(n06rlt tkm noted in Ixt It. It. TYPE OF LDR NOTIFMATION I CERTMATION C. i.> NOTIFICATION OI1LV: WASTES THAT CURRENTLY REQUIRE TREATMENT TO MEET THE 22 CCR ARTICLE 11 TREATMENT STANDARDS:==,22 CCR§6626&7(a)(1) _ 22 CCR 6662683(a)(2) I certify under penalty of law that 1 personally have examined and am familiar%fth Nie msw ffiAwgh analysis and testing rhrvugh knowledge 4 of the waste to support this cmifreatkvi,that the waste corWies with the treatrrie►rt stardaa�;specified in CCR Tide 22,D4ision 45,Chapter 18,Articles 4 and 11 and all apgplirab(e ptOhrGitfons Wr forlh in CCR Tide 22,SW.02"WM32 or RCRA Section 30040#42V S.r–Section 024(d)).L ba mvse that the kdomwtion I submitted is true,accurate and canW&,go 1 am aware Char there are sg fikant penalties for submitting a false certification.Lxluding rhe possWdty of a fare or irrys IW12ment. 3.a NOTIRCATION&CERT*=TM NON4KM WASTE THAT HAS BEEN TREATED AT AN OFF-M TREATMENT FACWIY SO AS TO MEET ALL APPL1CAt3LE 22 CCR ARTICLE 11 TREATMENT STANDAFDS: 22 CCH 56G2�71 b)(5) I certify underperie ty of Law that l persnnaJ/y hOV&examined and am farWfiar whir rhe virile thmUgh analysis and testing through knowledge of the waste to support this certifiratr on,that The waste complies with the tn�ment surd's speci&d in CCR Title 22,Dwision 4.5,Chapter 18,Articles 4 and t t and 811 appfirabk F1V b&inns set forth in CCR Title 2Z Sactbn b162fifit3l'or RCRA Sesbon 3004(d)t42 U.S.G Section 6924(d))./beige m drat the mfonmob vn I subaWod is true,a=rafe and cur Wkwa tam aware that there are sigriftant penalties Ihrsubmiltm-g a false certification,kx*AAW the possibWlyofa fine or imprfsonmerlL %i Ill.LDR NOT64CATION 1 CMI MATM 060MATION REOLIFIED BY n= s, rl`edr far ret 03 (D) appropriate C t2,rx 3 hors TraiTrnentem Started '' tn>as han88rrg b&nnadan + �1F ok t 1 29 s rq}trod Platt ENar�ira Data Trar�rtV Grotrptd i�1 1-143 tForn 22 CCR t_ 1 -'2 :3 1r�Gl96 AW-v®stm eantranirm S(fifi2r�79ta1&�2�t00(a'{1►j 1 86268.107 Tebbe 8 CCW 518181Auwshteddw amm tsamL29W&f'2G&Wo(aN33! I 6&'168.186TabFa-NGGINE 3.7 71 "2 : 1!1181 Ruartimm waste rV sand I652SL29(a3 do 66268.16War(511 4 8fi2f&196 Table 1.9 CCVA 4.X :"4 )(2 =3 11181 Fly&W bottmmtrt r ash,retoSqtt or boom®pays t !&66268.100talt8i1 7 6626&106 Table 1-0 CC1NE -12 ti1A1 aaglrousewastefrmt,kwadrie IG92M2 i1& I0301 8 t l(6TWel-EcWE 6. 1 :2 -3 Wm Asbestw ownui wasta identified in sedan(h^6Z6&mm!b W26at0ots111%I 12 tS26$.114 tither(Spadf* Copies of appt'rc0e treatment standards and waste anaiysis data(where avalWe)are malnMi ted at th0 feE lity ke fined on rm msrtifest rder—md above. s 1V. GENERATOR AUTHORIZATIONICERTIFtCATION 1 horeby certify that ahormatitxt submitted in Vs and afl amociated documents is true,complete,and aerate to the hest of my knowledge and inform4on,and ' th&no omissions or errors ejdsL I warrant that I am an authartod representative of the generator. E. AtrthoriZed Printed 1 Date q, TI AIS DOCUMENT, WITH AN ORIGINAL SIGNATURE, MUST AOCX)MPANY EACH WASTE SMPMEN'-". A COPY OF THIS CERTIFICATION, AND ALP. A5 PERCCR)yS6268.7 Rev_1 t 102 SIJ PPORTWG DATA MUST BE RETAINED 13Y THE GENf�ATOR FOR A LEAST FIVE(5)YEARS __