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EPA ID NUMBER Page 3 of I- V7. ATTAC D4ENTS: ® 1. A plot plan/map detailing the location(s) of the covered ut»i(s) in relation to that "W ;d. 51�q 2. A unit specific notification form for each unit to be covered at this location.- ,: ',CEJ VII. CERTIFICATIONS: 71ris form must be signed by an authorized corporate officer or any other person in the company who has operational control and performs decision-mating functions that govern operation of the facility(per title 22, California Cade of Regulations (CCR) section 66270.11). All thrne copies rnurt have original signatuner. 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 Certification I certify that the unit or units described in these documents meet the eligibility and operating requirements of state statutes and regulations for the indicated permitting tier, including generator and containment requirements. I understand that if any of the units operate tinder Permit by Rule or Conditional Authorization, I so be required to provide required financial assurances by January 1, 1994, and conduct a Phase I environmental assessment by January 1, 1995. 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. _R.t.�.AC.I �—n _ � ANrY , 'A. N�or Type) S1 �a��c- TiNe -z ct 3 Signature Date signed OPERATING REQUIREMENTS: Pkase note that generators treating hazardous waste onsite are required to comply wish a number of operating requirenaur which differ depending on the tiers) under which one operates. These operating requirements are ser forth in the siaruter and regulations, some of which are referenced in the Itter- p fire Faersheets. SUBMISSION PROCEDURES: You must Submit hta emia of this completed notiftcmion by certified mail, return receipt requested, to: Dgoanmet of Task Subrtanar Control Form 1772 Oaths Hazardous Waste Treannent Unit 400 P Street, 41h Floor(walk in only) P.O. Box 806 Sacramento, CA 95812-01406. Yon muss also mkntlt our sour of the notification and attachments to the local regulatory agency In your ju isditsion as ironed in the insrruesion materials. You math also retain a copy as part ofyour operating mord. All dune foram macs hale original signatures, nes phogaeopier. DISC 1772(1/93) pW*r 3-