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S- Clean Harbors Environmental Services, Inc. California Land Disposaf/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 1. If the waste is non- hazardous or not restricted then complete only the applicable portions in Part I and sign/date the Form at the bottom of page. Otherwise complete Part I,11,and IIi, and sign/date the Form at the bottom of page.(For RCRA wastes,use Clean Harbors RCRA FORMS) 1. GENERAL INFORMATION REGARDING GENERATOR&WASTE STREAM DTE Stockton.LLC PHONE: _209-320-3712 SITE_2526 West Washington Street Stockton,CA.95203 PROFILE NUMBER: CH1346380 IS THIS WASTE NON HAZARDOUS? X NO ❑YES (ff YES,stop here and sign/dWe form at the bottom of page) GENERATOR'S EPA IDN:GAL.00359102 MANIFEST#Agf95f1--GE CA WASTE CODE(S):_�71_ IS THIS WASTE RESTRICTED? 12 YES NO(!f NO,stop here and sign/date form at the bottom of page) THIS NOTIFICATION&CERTIFICATION IS BASED ON THE FOLLOWING WASTE STREAM INFORMATION: X(A)CHEMICALIPHYSICAL ANALYSIS OF THE WASTE; ❑(B)GENERATOR KNOWLEDGE OF THE WASTE;OR L(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 11(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 11. it. TYPE OF LDR NOTIFICATION f CERTIFICATION ❑ 1.> NOTIFICATION ONLY: WASTESTHAT CURRENTLY REQUIRE TREATMENT TO MEET THE 22 CCR ARTICLE 11 TREATMENT STANDARDS:=>22 CCR§66268.7(a)(1) X❑ b ml=>22 CCR§66268.7(a)(2) 1 certity underpenaltyof law that l personally have examined and am familiar with the waste through analysis and testing th rough 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 orRCRA Section 3004(di(42 U.S.C. Section 6914(d))./believe that the information I submitted is true,accurate and complete.I am 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 OFFSITE TREATMENT FACILITY SO AS TO MEET ALL APPLICABLE 22 CCR ARTICLE 11 TREATMENT STANDARDS:=t.22 CCR 966268.7(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 standards specified in CCR Title 11,Division 4.5,Chapter 18,Articles 4 and 11 and all applicable prohibitions set forth in CCR Title 21,Section 66268.32 orRCRA Section 3004(dJ(42 U.S.0 Section , 6924(d)).1 believe that the information I submitted is true,accurate and complete.I am aware that there are significant penalties fo r submitting a false ceaih'cation,including the possibility of a fine or imprisonment. IN.LDR NOTIFICATION/CERTIFICATION INFORMATION REQUIRED BY 22CCR Cheek (A) Ia1 1C1 (DI appropriate Check 11A,or 3 from Corresponding boxes handling information prohibition Subeategary of Restricted waste l22 CCR 66268.28 a-mi and Treatment Standard (Pmt 0) Effective Date Trutabirrtq Group(m)66260.100(a)(1-14) IFrom 22 CCR[ 1,p 01 G2 Dl 1r26190 Aqueous wastes contai ning metals 166268.29(6)&66268.100(a)(111 1 66266.107 Table I[CCW 2. 01 72 ❑3 518191 Auto shredder waste 168268.29(c)&66268.100(al(911 2 66268.106 Table-A CCVJE 3.C 01 02 ^3 111191 Hazardous waste foundry&and[66268.29(e)&66268.100(a)(511 4 66268.106 Table 1-6 CCWE 4.X Ell Lim 3 111191 Fly ash,bottom ash,Wort ash or baghouse waste[66268.29(h)&66268.10oia)(8)l 7 66268.106 Table I-D CCWE 5.;a Ct ❑2 D3 111191 Baghouse waste from foundries[66268.29(i)&66268.10oia11911 8 66268.106 Table I-E CWE 6.-] G1 02 1-3 311/93 Asbesto&containing waste identified in section(66268.29(ml&66268.100(aII13)1 12 66268.114 1-11 F12 [13 Other(Speelfy): 13 Copies of applicable treatment standards and waste analysis data(where available).are maintained at the facility identified on the manifest feferenced above. IV. GENERATOR AUTHORIZATION/CERTIFICATION I hereby certify that ell 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 ebst.I warrant that I am an authorized representative of the generator. �e �8- 9 uthorized ature Print6d 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.11/02 Page_of