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EIDA ID NUMBER Page 3 of VIII. 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 the faclllry (per Tule 22, Califontia Code of Regulations (CCR) Section 66270.11). All three copies must have originalsignarzow. _ 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 secondary containment requirements. I understand that if any of the units operate under Permit by Rule or Conditional Authorization, I will also be required to provide required financial assurance for closure of the treatment unit 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. Cam Name (Print or ) Signature Title Date Signed Please note that generators treating hazardous waste onsite are required to comply with a number of operating requirements which differ depending on the tier(s). These operating requirements are set forth in the statutes and regulations, some of which are referenced in the Tier -Specific Fact Sheets available from the Department's regional and headquarters offices. You must submit two comes of this completed notification by certified mail, return receipt requested, to: Department of Toxic Substances Control Program Data Management Season 400 P Street, 4th Floor, Room 4453 (walk in only) P.O. Bos 806 Sacramento, CA 95812-0806. You must also submit one couv of the notification and attachments to the local regulatory agency in your jurisdiction as luted in Appendix 2 of the instruction materials. You must also retain a copy as pan of your operating record. All three forms must have original signatures, not photocapies. DTSC 1772 (1/95) Page 3