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<br /> Sean Harbors Environmental Services, Inc. California land DisposaVRestriction Information
<br /> Notiflcatiori/CertipCBtion Form
<br /> ti:3 form is submitted In accordance with the requirements of 22 CCR 66268.7(a)Chapter 18 which restricts land disposal of certain haiardous wastes,The appropriate
<br /> elifomia rraste code(s)and applicable non-RCRA hazardous waste listings from CCR 66258.29 are noted below.Complete all portions of Part I- If the waste is non,
<br /> hzardous or not restrlcied then complete only the applicable portions in Part 1 and sign/date the Form at the bottom of page. Otherwise complete Part I,q;and III;
<br /> 1d sign/date the Form at the bottom of page.(For RCRAwastes,use Clean Harbors RCRA FORMS)
<br /> GENERAL INFORMATION pEGARatNG GENERATOR 8 WASTE STREAM x
<br /> i
<br /> DTE Stockton.LLC PHONE:__209.320..3712..__-SITE_2526 West Washington Street Stockton,CAL 85263
<br /> .a,
<br /> PROFILE NUMBER: rCH6417538JS THIS WASTE NON HAZARDOUS? X NO " YES !
<br /> (d YES,stop here and sigrVda to roan at the bottom of page)
<br /> GENERATOR'S EPA ION: S6p„Q,}395102 MANIFEST M °Ali CA WASTE CODE(S): 571 IS THIS WASTE RESTRICTED? x YES
<br /> NO(d NO,stop here and sigrVdate form at the bottom of page)
<br /> THIS NOTIFICATION&CERTIFICATION IS BASED ON THE FOLLOWING WASTE STREAM INFORMATION: wi
<br /> es
<br /> 11(A)CHEMICAL(PHYSICAL ANALYSIS OF THE WASTE; (B)GENERATOR KNOWLEDGE OF THE WASTE;OR W(C)BOTH
<br /> heck the appropriate boxes in Parts It and III.If only one applies,then til(A)isnot required,For multiple certlficadanslnotifiratians,the appropriate choices from Part
<br /> M
<br /> (t-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.fk(A),1-3,you are
<br /> along the certification l no0calion noted in Part II.
<br /> .. TYPE OF LDR NOTIFICATION/CERTIFICATION
<br /> ❑ 1.> NOTIFICATION ONLY: WASTES THAT CURRENTLY REOUIRE TREATMENT TO MEET THE 22 CCR ARTICLE 11 TREATMENT
<br /> STANDARDS-.=-22 CCR 966268.1.(a)(t)
<br /> X :i.5 a�=22 CCR 166269.7ta)(2)
<br /> I certify underpenaftleof law that 1 personally have examinedand em familiar with the waste through analysis and tasting thmurgh knowledge '
<br /> of the waste to support this cerrification,that the waste complies with the treatment standards specified in CCR Trite 22;Division 4.5,Chapter u
<br /> 18,Articies 4 and I I and all applicable prohibitions set forrh in CCR Title 22°Section 6616822 or RCRA Section 3004(d941 Us r-Section
<br /> 6914(d)).I believe that the information t submitted is true,accurate and complete.lam aware that their:are significant penalties forsubmitting
<br /> a false certirrcation,including the possibility of a me ar fmpr/sanment.
<br /> 3.>..IVOTIFICATION✓ CERTIFICATION: NON-RCRA WASTE THAT HAS BEEN TREATED AT AN OFF-SITE TREATMENT FACILITY SO AS TO
<br /> MEET ALL APPLICABLE 22 CCR ARTICLE 11 TREATMENT STANDARDS:=22 CCR 166268.7(b)(5)
<br /> 1 certify underpeneltydflaw that 1personaliy have examined and am familiar with the waste through analysis and testing through knowledge "l
<br /> of tha waste to supporr this cerrifiration,that rhe waste complies with the treatment standards specified"ire CCR Title 11,Di vision 4.5,Chapter
<br /> t6 A rticles 4 and 11 and all applicable prohibitions set forth in CCR 7R/e 11,Section 6616637 orRCRA Section 3004tdV41 U.$,C.Sec;taiin
<br /> e974(d)1.1 believe that the information f sub mirred is rave,accurate and complete,f am eware that there are significant penalties for submlrting
<br /> a false certircation,including the po ssibility ofe find o r impriso nment.
<br /> I.LDR NOTIFICATION 1 CERTIF1CA nON INFORMATION REQUIRED BY 22CCR
<br /> Cnsck
<br /> CAI I9t ICI Io6
<br /> appropriate Crack 1,2,or Imam Cn.reap—&-no
<br /> bores handintg hnrormatlen Prohibition &ubearagery of Restricted Waste 172 CCR 682Ee.29 a+nl and Treatment 81vial el
<br /> iPart 11 iffactive6ate Treaublrrty erouptal 66268.1DOIalt1.141 Threat T2 CCRI
<br /> 2 -] 11,7690 Aqueava wastes conaining metals 15526e,281a1 d wm.lmar9 i 1 W29R,197 Tatiio 11 MV
<br /> 2. 3 ':2 .'�3 Iasi Auto st^redderwasiei6626fh.29tclfk6e2aa,vowr7li 2 66269.106Tab=e•ACC4:E
<br /> 3. 3 ..:2 '.3 1:191 1laaardous%-are foundry sand ISM68.29ls1 h 562Ee.1001alit-1 4 66760:106 Tobin 1.8 CC`h!;-
<br /> a?
<br /> a.X 1 }(2 3 V1,911 Fiv ash,bottom ash,wort atrt or baghousewasts JW269.291ti�6 66238.hG01a'�81? 7 6625x3:106 Torre 1d5 CCLA
<br /> 11191 -f3aghousewaste tramfoundries(66259.2%)b6r57E6.1001a1f91$ 8 562011 Table I-EVNE
<br /> E.' -1 2 :3 11,93 Aabestaswra&Wngwaste iderordinseaion[66261.29irml 12 C62581r4
<br /> Z` :::...! 2 ,3 Other 95paci1Y7: 13
<br /> `=7
<br /> Copies of applicable treatment standards and waste analysis data(where avaliabte)are maintained at the facility identified on the manifest referenced above..
<br /> V. GENERATOR AUTHORIZATIONMERTIFICATION;
<br /> I hereby certify that M Irlfcrmatiori submitted in this grid all associated dol Unients is truecom ete,and accurate to the best d m knowted a and informalO.,_, I� y g .and
<br /> that no omissions or errors exist.l warrant that I am an authorized representative of the generator,
<br /> �q
<br /> Authorized Wature Printed ame,.,m.. Title 4F Date
<br /> 'HIS DOCUMENT, WITH A—N ORIGINAL SIGNATURE, MUST ACCOMPANY EACH WASTE SHIPMENT..A COPY OF THIS CERTIFICATION, AND ALL
<br /> iUPPORTING DATA,MUST BE RETAINED BY THE GENERATOR FOR A LEAST FIVE(5)YEARS AS P ER 22 CCR 556269.7 Rev,11,,02 Page_of
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