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EPA ID Number CA L 0 0 0 2 6 9 3 7 5 OMB#: 2050-0024; Expires 01/31/2017 <br /> 12. Notification of Hazardous Secondary Material (HSM)Activity <br /> Y❑ N 0 Are you notifying under 40 CFR 260.42 that you will begin managing, are managing,or will stop managing hazardous <br /> secondary material under 40 CFR 261.2(a)(2)(ii),40 CFR 261.4(a)(23), (24),or(25)? <br /> If"Yes,"you must fill out the Addendum to the Site Identification Form: Notification for Managing Hazardous Secondary <br /> Material. <br /> 13. Comments <br /> No Secondary Material <br /> Site is currently using a State EPA ID number and this application is for a new Federal EPA ID Number. The State EPA ID <br /> number will be inactivated once the new Federal EPA ID number is obtained. <br /> 14. Certification. I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in <br /> accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based <br /> on my inquiry of the person or persons who manage the system,or those persons directly responsible for gathering the information, the <br /> information submitted is,to the best of my knowledge and belief,true,accurate,and complete. I am aware that there are significant <br /> penalties for submitting false information,including the possibility of fines and imprisonment for knowing violations. For the RCRA <br /> Hazardous Waste Part A Permit Application, all owner(s)and operator(s) must sign(see 40 CFR 270.10(b)and 270.11). <br /> Signature of legal owner, operator,or an Name and Official Title(type or print) Date Signed <br /> authorized representative (rnm/dd/yyyy) <br /> Charina Gaspay, REM 06/27/2018 <br /> EPA Form 8700-12, 8700-13 A/B, 8700-23 <br /> Page 4 of 4 <br />