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EPA ID NUMBER CADOO4 1 A-L 9279 Page 3 of k *so VI. ATTACIIMENTS: 19 1. A plot plan/map detailing the location(s) of the covered unit(s) in relation to the facility boundaries. IN 2. A unit specific notification form for each unit to be covered at this location. VII. CERTIFICATIONS: This form must be signed by an authorized corporate officer or any other person in the company,who has operational control and performs decision-making functions that govern operation of ritefacility(per tick 22, California Code of Regulations (CCR) section 66270.11). All three copier must have original signatures. Waste Minimization I certify that I have a program in place to reduce the volume, quantity, and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health and the environment. Tiered Permitting rtificati n I%ertifvthat the unit or ftits de=ibed in these d men meet the eligibili andta,rating requirements f tate statutes and re1 tons for the indicat twitting tier, includin enerator and secondarytai requirements. understand that if any a units operate under smut by Rule or Conditi Authorvation, I will alsod ;to providefinancial as%ran by anuary 1, 1994 d c duct a Phase I env' onm assessment by 7 . I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those directly responsible for gathering the information, the information is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are substantial penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations. 'DaUltl Tl� M;11awu6aua�, Pla.,k-- Mawtanri^ Name (Print or Type) Title � r m tS o,$.w Q 3 -31- 93 Signature Date Signed OPERATING REQUIREMENTS: Please note that generators treating hazardous waste ons(re are required to comply with a number of operating requirements which differ depending on the tier(s) under which one operates. These operating requirements are set forth in the statues and regulations, some of which are referenced in the Tier-Specific Factsheets. SUBMISSION PROCEDURES: You must submit two conic of this completed notification by certified mail, return receipt requested, to: Department of Toodc Substances Control Form 1772 Onsite Hazardous Waste Treatment Unit 400 P Street, 4th Floor(walk in only) P.O. Bos 806 Sacramento, CA 95812-0806. You must also submit one cow of the notification and attachments to the local regulatory agency in your jurisdiction as listed in the instruction materials. You must also retain a copy as pan of your operating record. All three forms must have original signatures, not photocopies. DTSC 1772 (1/93) Page 3