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Clean Harbors Environmental Services, Inc. California Land Disposal/Restriction Information Notification/Certification 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 California 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- hazardous or not restricted then complete only the applicable portions in Part I and sign/date the Fenn at the bottom of page. Otherwise complete Part I,II,and III, and sign/date the Form at the bottom of page. (For RCRA wastes,use Clean Harbors RCRA FORMS) I. GENERAL INFORMATION REGARDING GENERATOR&WASTE STREAM DTE Stockton,LLC_PHONE: 209-320.3712 SITE_2526 West Washington Street Stockton,CA.95203 PROFILENUMBER: CH1346380 ISTHISWASTENON HAZARDOUS? XNO -YES (if YES,stop here and slgrVdate form at the bottom of page) GENERATOR'S EPA ID#: CAL00359102 MANIFEST#:011PY317" CA WASTE CODE(S)_571 IS THIS WASTE RESTRICTED? k YES NO(if NO,stop here and signidate form at the bottom of page) THIS NOTIFICATION&CERTIFICATION IS BASED ON THE FOLLOWING WASTE STREAM INFORMATION: X(A)CHEMICAUPHYSICAL ANALYSIS OF THE WASTE; C(B)GENERATOR KNOWLEDGE OF THE WASTE;OR (C)BOTH Check 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 II(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 III(A), 1-3,you are making the certification/notification noted in Part II. IL TYPE OF LDR NOTIFICATION/CERTIFICATION ❑ 1.> NOTIFICATION ONLY: WASTES THAT CURRENTLY REQUIRE TREATMENT TO MEET THE 22 CCR ARTICLE 11 TREATMENT STANDARDS:a22 CCR§66268.7(a)(1) X S a4o 22 CCR§66268.7(a)(2) /certify underpena/tyof 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 11,Section 66268.32 orRCRA Section 30041d)(42 U.S.C. Section 6924(d)).l believe that the information/submitted is true,accurate and complete. l am aware that there are significant penalties for submittin§ a false certification,including the possibility of fine orimprisonmem 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 §66268.71b)(5) /certify underpena/ty of law that/personally have examinadandam 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 66268.32 or RCRA Section 3004(d)(42 U.S.C. Section 6924(d))./believe that the information/submitted is true,accurate and complete./am aware that there are significantpena/ties for submitting a false certification,including the possibility of a fine or imprisonment. III.LDR NOTIFICATION/CERTIFICATION INFORMATION REQUIRED BY 22CCR Check IA) 181 [C1 IDI appropriate Check 1.2,or 3 from Conneiponding bo.es handling information Prohibition Subcategory of Restricted Wasta(22 CCR 66268.29 ayn)and Trastmant Standard (Pan e) Effective Date Tmatability Greup[s)66268.100(.)(1-141 IFmm 22 CCR) 1._ Cl -2 3 1/2690 Aqueous wastes containing metals[66268.2Ma)&66268.100(a)(1)I 1 66268.107 Table II CCW 2. 1 -2 3 519191 Auto sh redder waste 156268.291c1&66268.100(a)(3)I 2 66268.106 Table,A CCWE 3. 1 _2 3 1/1191 Hazardous waste foundry sand(66268.291e)&66268.10 Mails)] 4 66268.106 Table l-e CCWE 4.X -1 M 3 Ilml Fly ash,bottom ash,retortash or beghwsewasle 166268.29(h)&66268.100(m)(811 7 66268.106 Table I-D CCWE 5.. .1 @ -3 1/1/91 Baghouse waste from foundries166268.29111&66268.100(all9)I 8 66268.106 Table I-E CRE 6. Ct S2 3 3/193 Asbestos containing waste identified In section[66261&66268.100(a)(13)1 12 66268.114 7. -1 2 3 OtherspaeHy): 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 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. I warrant that I am an authorized representative of the generator. lit""1;' A ;,,, fir/Lo S�ic.Sof �� Authorized Signature Printed Name Title 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.11102 Page_of