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J Mean Harbors Environmental Services, Inc. California Land Disposal/Restriction Information Notification/Certification Form Phis for,-.is submitted in accordance with the requirements of 22 CCR 66268.7(a)Chapter 18 which restricts land dispa,4 of certain hazardouswastes. The appropriate Dalifom;a waste codes)and applicable non-RCRA hazardous waste listings from CCR 66268.29 are noted below.C(cnplete all portions of Part I, if the waste is non- K lazardcyLis or not restricted then complete only the applicable portions in Part l and sign 1 date the Form at the bottom of page. Otherwise complete Part 1, 11, and 111. fi and sig ;date the Form at the bottom of page. (For RCRA wastes,use Clean Harbors RCRA FORMS) GENERAL INFORMATION REGARDING GENERATOR&WASTE STREAM [GENERATOR'SEPAID#: TE Stockton.LLC PHONE: 20 24.3712 SITE_2526 West Washington Street Stockton,CA.95203 UFII-E NUMBER: _CH641753B IS THIS WASTE NON HAZARDOUS? X NO YES YES. stop here and sign/date form at the bottom of page) CAL00 59102 MANIFEST#: S$3 FGCCAWASTECODE(S):571 _IS THIS WASTE RESTRICTED? xYES (if NO,stop here and sigrl/date form at the bottom of page) THIS NOTIFICATION&CERTIFICATION IS BASED ON THE FOLLOWING WASTE STREAM INFORMATION: K (A)CHEMICALIPHYSICAL ANALYSIS OF THE WASTE; -(B)GENERATOR KNOWLEDGE OF THE WASTE;OR (C)BOTH heck the appropriate boxes in Parts and III.If only one applies,then III(A) is not required.For multiple certifiaationslnotifications,the appropriate choices from Part II 1(1-3)may be 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 III(A),1-3,you are raking the certification/notification noted in Part 11. I. TYPE OF LDR NOTIFICATION/CERTIFICATION FIXlnr 1.> NOTIFICATION ONLY: WASTES THAT CURRENTLY REQUIRE TREATMENT TO MEET THE 22 CCR ARTICLE 11 TREATMENTSTANDARDS-=*22 CCR§66268.7(a)(1) 22 CCR §66268.71a)(2y J certify underpenalty of law that 1 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 standards specified in CCR Title 22,Division 4.5, Chapter 18,Articles 4 and 17 and all applicable prohibitions set forth in CCR Title 22,Section 66268.32 o r RCRA Section 3004(d)(42 U.S.C. Section a 6324(d))./believe that the information J submitted is true,accurate and complete.Jam aware that there are significant penalties for submitting a false certification,including the possibility of a 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(bl(5I J certify underpenaltyof 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 standards specified in CCR Title 22, Division 4.5, Chapter 18,Articles 4 and I land all applicable prohibitions set forth in CCR Ttle 22,Section 66268.32 or RCRA Section 3004(d)(42 U.S.C. Section 5924(d)).l believe that the information I submitted is true,accurate and complete.1 am aware t'at there are significant penalties forsubmitting a false certification,including the possibility of a fine or imprisonment. Ill,LDR NOTIFICATION/CERTIFICATION INFORMATION REQUIRED BY 22CCR Check (A) (BI ICI I Corresponding appropriate Check 1,2,or 3from Treatment Standard boxes handling information Prohibition Subcategory of Restricted Waste 122 CCR 66268.29 atnl and (Part 111 Effective Date Treatability Groups)66268.100J810.14I (From 22 CCRI 1. '1 -2 .3 1:26190 Aqueous wastes containing metals 166258.29(al&66268.1 DOW 1'4; 771 66258.107 Table 11 CCW ..1 2 3 5.�&91 Aum shredder waste N6268.29(c)&66258.100(80)] 2�621.106 Table-A MNE.2 .3Hazardous waste foundry sand 166268.291x}&66268.100W!5if46269.tOfi Table 1-8 CCVV'E X 1 I{2 3 1;1151 Fly ashr bottom ash,retort ash or baghouse waste[66268.2%h?i4 66268-106{ai[8li 7 66268.106 Table I-D CCbVE -1 -2 3 Sf1r91 Baghause waste from foundries[6626B.29(i)&E6258.100(a)(9)1 6 66268.106 Table I-E CWE --1 .2 -3 311,53 Asbestos containing waste idenofled in section[66258.29(m)&�56268,ioo{sIS13); 12 666258.114 _ -1 _2 -3 Other lSpecify;: 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 - I hereby cenifythat 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.I warrant that I am an authorized representative of the generator, y�'j9 Au`tlorized S afore Printed ame Title Date THIS DOCUMENT, WITH AN ORIGINAL SIGNATURE, MUST ACCOMPANY EACH WASTE SHIPMENT. A COPY OF THIS CERTIFICATION, AND ALL SL PP;]RTING DATA,MUST BE RETAINED BY THE GENERATOR FOR A LEAST FIVE(5)YEARS AS PER ZI CCR§66268.7 Rev.11;'02 Page-of