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EPA ID NUMBER C 122033_ Page 3 of_10 <br /> Vi. ATTACIIlIIENTS: <br /> 1 ® 1. A plot plan/map detailing the location(s) of the covered unit(s) in relation to the facility boundaries. <br /> x❑ 2. A unit specific notification form for each unit to be covered at this location. <br /> VII. CERTIFICATIONS: This form must be signed by an authorized corporate officer or any other person in the company who <br /> has operational control andpetforms decision-making functions that govern operation of the facility (per title 21, California <br /> Code of Regulations (CCR) section 66170.11). All three copier must have original signatures. <br /> WasteMinimizationI certify that I have a program in place to reduce the volume, quantity, and toxicity of waste generated to the <br /> degree I have determined to be economically practicable and that i have selected the practicable method of treatment, storage, or <br /> disposal currently available to me which minimizes the present and future threat to human health and the environment. <br /> Tiered Permitting Certification 1 certify that the unit or units described in these documents meet the eligibility and operating <br /> requirements of state statutes and regulations for the indicated permitting tier, including generator and secondary containment <br /> requirements. I understand that if any of the units operate under Permit by Rule or Conditional Authorization, I will also be required <br /> to provide required financial assurances by January 1, 1994, and conduct a Phase I environmental assessment by January 1. 1995. <br /> I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance <br /> with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry <br /> of the person or persons who manage the system, or those directly responsible for gathering the information, the information is, to <br /> the best of my knowledge and belief, true, accurate, and complete. <br /> I am aware that there are substantial penalties for submitting false information, including the possibility of fines and imprisonment <br /> for knowing violations. <br /> TH M l PRRRT FNT <br /> Name (Priv 0r Type) Title <br /> Signature <br /> Dale Signed <br /> OPERATING REQUIRE1N EWS: <br /> Please note that generators treating hazardous waste onsite are required to comply with a number of operating requirements which <br /> differ depending on the tiers) under which one operates. These operating requirements are ser forth in the statutes and regulations, <br /> some of which are referenced in the Tier-Specific Factsheets. <br /> SUBMISSION PROCEDURES! <br /> You must submit tKw copies of this completed notification by certified mail, return receipt requested, to: <br /> Department of Toxic Substances Control <br /> Form 1772 <br /> Onsite Hazardous Waste Treatment Unit <br /> 400 P Street, 4th Floor (walk in only) <br /> P.O. Bos 806 <br /> Sacramento, CA 95812-0806. <br /> •u must also submit one cow of the notification and attachments to the local regulatory agency in your jurisdiction as listed in the <br /> tstruction materials. You must also retain a copy as pan of sour operating record. <br /> All three forms must have original signatures, not photocopies. <br /> DTSC 1772 (1/93) Page 3 <br />