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CIE°an Harbors Environmental Services, Inc. California Land Disposal/Restriction Information Notification/Cer ification Form t'hia Conn is submitted in accordance with the requirements of 22 CCR 66268.7(a)Chapter 16 which restricts land di:iposai of certain hazardous wastes. The appropriate :ali€omia waste code(s)and applicable non-RCRA hazardous waste listings from CCR 66268.29 are noted below.Complete all portions of Part I. if the waste is non- 7az3rdous or notrestricted then complete only the applicable portions in Part I and sign/date the Form at the bcttom of page. Otherwise complete Part I, Il, 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:,209-320-3712 SITE_2526 West Washington Street Stockton,CA.95203 PROFILE NUMBER: _CH641753B IS THIS WASTE NON HAZARDOUS? X NO _YES (rf YES,stop here and sigrVdate form at tpre bottom of page) GENERATOR'S EPA€D#: CAL00359.102 MANIFEST 0: CCAWASTE CODE(S):57hIS THIS WASTE RESTRICTED? x YES NO(if NO,stop here and sign/date form at the bottom of page) THIS NOTIFICATION&CERTIFICATION IS BASED ON THE FOLLOWING WASTE STREAM INFORMATION: W (A)CHEMICAL/PHYSICAL ANALYSIS OF THE WASTE; =(B)GENERATOR KNOWLEDGE OF THE WASTE;OR -(C)BOTH 'he+ck the appropriate boxes in Parts II and III.If only one applies,then III(A)is not required.For multiple certifications/notifications,the appropriate choices from Part I(1-3)may be marked in Part III(A)to indicate how waste is to be managed to conform with Land Disposal Restric ions. By selecting an item in Part III(A),1-3,you are naldng the certification/notification noted in Part II, I. TYPE OF LDR NOTIFICATION 1 CERTIFICATION D 1.> NOTIFICATION ONLY: WASTES THAT CURRENTLY REQUIRE TREATMENT TO MEET THE 22 CCR ARTICLE 11 TREATMENT STANDARDS:=>22 CCR§66266.7(a)(1) X_ 22 CCR§66268.7(al(2) I certify under penalty of law that l personally ha ve 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 standarcrs specified in CCR Title 22,Division 4.5,Chapter 16,Articles 4 and 11 and all applicable prohibitions set forth in CCR Title 22,Section 66268.3T or RCRA Section 3004(d)(42 U.S.C. Section 6924(d)).l believe that the information 1 submitted is true,accurate and complete. lam aware•that there are significant penalties for submitting a false certification,including the possibility of Tine or imprisonment. 3.>NOTIFICATION&CERTIFICATION: NON-RCRA WASTE THAT HAS SEEN TREATED AT AN OFF-SITE TREATMENT FACILITY SO AS TO MEET ALL APPLICABLE 22 CCR ARTICLE 11 TREATMENT STANDARDS: =>22 CCR 366268.7{b)(5) I certify under penalty of law that I 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 standarcrs specified in CCR Title 22,Division 4.5, Chapter 79,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)).1 believe that the information I submitted is true,accurate and complete.1 am aware that there are significant penalties for submitting a false certification,including the possibility of a fine or imprisonment. Ill.LOR NOTIFICATION/CERTIFICATION INFORMATION REQUIRED BY 22CCR Check IA) (61 (C) IDI appropriate Check 1,2,or 3 from Corresponding bores handling inlerrmation Prohibition subcategory of Restricted Waste 122 CCR 66268.29 a-rnl and Treatment Standard (Part I!) Effective Date Treatability Groupls)66268.100(a)(1-14) [From 22 CCRI 1 -.2 _3 1;26;56 Aqueous wastes containing metals[66268.2%a]&66258.100(a;111, 1 65268.107 Table 11 CCW �. -1 .2 3 518i91 Auto shredderwasie[66268.29(c3&56268.100(a)(3)] 2 66268.106Tahla-A CC14E ... 1 _2 '3 1119` Hazardous waste foundry sand 166268.29(e)&66268.10OWi5ri 4 66268.10ETable 1-9CCVJE 4.X 1 X2 :3 111191 Fly ash,bottom ash,retort ash or baghouse waste[66268.29(11, &66268.106{a3(&i 7 66268.106 Table 1-0 CME ❑.- -1 -2 -.3 11:91 8aghousewastefrom foundries 166268.29{i1&66268.100(a[(9) 8 66268.106 Table 1-E CtNE E. -1 2 -:3 111 Asbestos containing waste identified in section[6626a,29(m)&66268.1=aiI13;; 12 66258114 7. 1 _2 -3 Cther(Spscifyi. 13 Copies of applicable treatment standards and waste analysis data(where available)are maintained at the fac Iity identified on the manifest referenced above. IV. GENERATOR AUT HORIZATION/CERTIFICATION 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.{warrant that I am an authorized representative of the generator. 5-19 Authofized S' ature Printed Kame Title Date THS DOCUMENT, WITH AN ORIGINAL SIGNATURE, MUST ACCOMPANY EACH WASTE SHIPMENT A COPY OF THIS CERTIFICATION. AND ALL SL PPORTiNG DATA,MUST BE RETAINED BY THE GENERATOR FOR A LEAST FIVE(5)YEARS AS PER 22 CCR§66268.7 Rev.11,02 Page-of