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C;UFORNIA L-.NC CiSPCEAL RES T R(CT(CN NCTIFiC:.TiCN ANO CERTiFiCAi1CN leratcr •tame jK/ A91�1lG� ��//`�3- .lantresi Vur'toer ��G�f�j S anerator Address )qp, 7,V.%4 =,ohle vumcer ,� 16� :a„iornla ra:arcous ,Yas;e t�;,Celsi � `.:s term.s submirrea to C,amleai Waste Management. no.In acco canoe w,tn the recuiremenrs or CCR Title 22 C doter t8.Areae I.wnicn restricts ne ianc .aeosat or certain nazaraous wastes. I have manxea the aoproonate box (boxes A tnrougn 01 beiow to indicate now my waste must be managed to cantcrm n*land dlsodsal restrlctlans. A oocy of all a.nclicabte treatment Staneards and waste analysis data. 'wnere avallabte, IS maintained at tlis C,emtcal Waste •'.anagement facility icenufisa on the manifest referenced above. I have entered ne anoroonate Califamia Waste Code ana checked trio anprconate box In .h•table below to Indicate trio aaplicable non-RCRA hazuaous vast@ listing rrcm 22 CCA 1 66258.x. J Prohlbttlon C;aaesponaing State of California Implementation Treatment Standard Restricted Wasta Oeacrfitrtlon Ustad In 22 CCA f 66268.29 Date (frost 22 CCR) t1e•a'c-r^t�tn'Za +a r ous w-ere Id rtmied 1n "r—S -(q) De7cl wa 1ricin � SIM t I! ` II n oa c use.rnr•tre unetie Innnn.......w t.+rnr?;-g in Sec*ieh 56250,,wral r±1/r11/O+ II � A 1rYc/ fro, II , Y _ I I 7 "otid Wgrt. 1 in e rix + o II a RV nen_ tomm arotert !Ism sm or baahouse waste Ifi ;n �"'8"`a?t1 I rNfrit/Q1 i sh 1r`F,lnl/d1 I� 1 0 Q "'niffi-In I uncriai leefft.Tfad in ,actrin aR /O1 gem t in 29 I i ,1tairtina arcan- 'b /t!y 51268 lil- ��r ..rvwnl Hoc±ractfdrederurttt•Trte+ ;; �, - .dI31 13 Asbestascontalning waste identrfted In Zeman 662SIRM(m). I 03/01/93 I 68268.114 A. RESTRICTED WASTE REQUIRES TREATMENT I am the generator of the waste identified above wnicn must be treated to meet the appucable treatment stanaaras set tarts in CCA l Itle 22.Article 4 or Article 1 1 of Chanter 18. 9.1 RESTRICTED WASTE TRE.ATEO TO PERFORMANCE STANDARDS "cenrry under oenarryat law rnat i nate Cersonalry erammeo and am ramivar wrm re treatment teennology and eoerauon or rite rreatmenr ortacess use@ .a supporr this candeatron and that Cased uoon my,nouiry or c^ore rr.•onr;,a:;rr+.^ec;at-r,rssxns.z;z,fir ccra;ning rrs rr.rot-tanon,;Derie,v rear the treatment process nas been operated and maintained DeOPOny so as to comory wnn re perrcrmance levers soecrried in Article 4 and Article 1 i of Chapter 18, Division 4.5, i rile 22 CCR ana all aophcable prvnrbrdons ser harm in section 66268.32 or RCRA section 3004(4) (42 U.S.C.Section 6924(d)/widaur irrmoermrssro/e dilution of the prnnrbrtea waste. i am aware mat mere are signnicanr penarties ror sucmrrting a raise cemfrcatton•including To oossiorliry of a fine and imprisonment.' 81 RESTRICTED ASBESTOS WASTE TREATED TO PERFORMANCE STANDARD. 1 warrant that I am an authorized representative of the generator. I certify under penalty of law that the waste comolies with the treatment stanaardS specified In CCR. Title 22, Division 4.5. Chabter 18, section 66268.114 I believe that the Iniormation 1 suommea is true,accurate,and compiete. I am aware that there are significant penalties for submitting a talse certification. Including the Dossrbility of a fine and imprisonment.' C. RESTRICTED WASTE SUBJECT TO AN EXEMPTION (22 CCA 66268.7(a)(3)] The waste identified above Is subject to a prohibition imolementauon date of 0. RESTRICTED WASTE CAN BE LAND DISPOSED WITHOUT TREATMENT .l cenrly under penany of law mat 1 personairy nage examined and am familiar wrtn me waste (r1rougo analysis and resting or rrougn knowledge or the waste ro support mis certfrcation, mat me waste compties wrrn trte treatment srandarvs soecdiied in CCR Title 22, Division 4.5,Chapter 18,Article 4 and Article l I and all applicable pronibirions set forth in CCR Title 22.Section 66268.:2 or ACRA Section 2004id) (12 U.S.C.Section 6924(d)/. i am aware rnat mere are signdicant penanies for suomtrrng a false cerrrdcarron, inctuarng me possrodrty or a rine and imcnsonmenC Oren Ity that ail informauon submitted in this ana all associated documents IS comolete and accurate to the best of my knowledge and information. ignature: �� Date• .rtnonzea Reoresentative Print Name: Title: 0: Generator address and prtnnrd name or aurnonzect reDmsenratrve required fpr Bar 8.2 :aovrlent 0 x/'9/95. Chemtcii 'waste Management. 'tic. - ..,amu„a.