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Clean Harbors Environmental Services, Inc. California Land Disposal/Restrictiorf Information NotincationiCertification 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. K 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,Il,and III, and sign/date the Form at the bottom of page.(For RCRA wastes,use Gean Harbors RCRA FORMS) 1. GENERAL INFORMATION REGARDING GENERATOR&WASTE STREAM bTE Stockton.LLC PHONE:T,2t?9-320-3712 SITE_2526 West Washington Street Stockton,CA.95203 PROFILE NUMBER: _CH1346380 IS THIS WASTE NON HAZARDOUS? X NO ❑YES (if YES,stop here and sigNdate form at the bottom of page) GENERATOR'S EPA IDtf: CALtIWWJ02_ MANIFEST it:o1P97s!.3r�FI�CA WASTE CODE(S):571_ lS THIS WASTE RESTRICTED? X YES NO(rf NO,stop here and sigr0date form at the bottom of page) THIS NOTIFICATION R CERTIFICATION IS BASED ON THE FOLLOWING WASTE STREAM INFORMATION: X(A)CHEM ICAL/PHYSI CAL ANALYSIS OF THE WASTE; ❑(B)GENERATOR KNOWLEDGE OF THE WASTE;OR ❑(C)BOTH Check the appropriate bones in Parts It and Il[.If only one applies,then III(A) is not required.For multiple cerirfications/notftations,the appropriate choices from Part II(1-3)maybe marked in Pari 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 ar e making the certification/notification noted in Part 11. 11. TYPE OF LDR NOTIFICATION/CERTIFICATION ❑ 1.> NOTIFICATION ONLY: WASTES THAT CURRENTLY REQUIRE TREATMENT TO MEET THE 22 CCR ARTICLE 11 TREATMENT STANDARDS:=>22 CCR§66266.7(a)(1) X❑ RKN22 CCR§66268.7(a)(2) I certify underpena/ty of law that./personally have examined and am familiar with the waste through analysis and testing through knowlar eje of the waste to support this certification,that the waste complies with the treatment standards specified in CCR Title 22,Division 4.5,Chapte 18,Articles.4 and I I and all applicable prohibitions set forth in CCR Title 22,Section 66268.32 or RCRA Section 3004(d)(42 U.S.G Section 6924d))./believe that tha information/submitted is tnfe,accurate and complete./am aware that there are significant penalties forsubmirti,7g 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(b)(5) I certify under penalty of law that I personally have examined and am familiar with the waste through analysis and testing through knowledile of the waste to support this certification,that the waste complies with the treatmant standards specified in CCR rtle 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)).1 believe that the information I submitted is true,accurate and complete.1 am aware that there are significant penalties for submittirig a false certification,including the possibility of fine orimpnsonment. III,LDR NOTIFICATION/CERTIFICATION INFORMATION REQUIRED BY 22CCR >� Check (A) la1 lei 10) appropriate Check 1,2,or 3 from Corresponding boxes handing information Profdbttion 6ubcateaory of RwWcted Waste(22 CCR MUM a-ml and Treatment Standard (Part 11 Effective Date Treatability Groupie)08268.100(a)(1-141 [From 22 CCRI 1.0 G1 02 113 112ew Aqueous wastes containing metals 166256,29(a)&66268.100(alllll 1 66268.107 Table II CCW 2.0 01 02 113 5Bl91 Auto shredder waste[66268.29(c)&66268.100(al(311 2 66268.106 Table-A CCWE 3.[3 ❑l 02 03 111191 Harardoua waste foundry sand[66268.29(e)&66268.100(a)(5)] 4 66268.106 Table 1-13 CCWE 4.X 01 CzX 3 111191 Fly ash,bottom ash,retort ash or baghouse waste IW268.29(h)&66268.100311 7 66268.106 Table I-0 CCWE 5. U1 02 03 1/1191 Raghouse waste from foundries[66268.291i1&66268.100(a)(911 8 66268.106 Table I-E CWE 6.u U1 02 �:3 ai1793 Asbestos containing waste iden6ried in sedan[66268.29(m)&66268.100(a)(1311 12 66266.114 7.0 1 ❑2 F1 Other(SpecfyY 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 e)dst.I warrant that I am an authorized representative of the generator. / A-J"o x uthorized ature Prhft Name Title THIS DOCUMENT, WITH AN ORIGINAL SIGNATURE, MAST 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