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EPA ID NUMBER CAD 98089318 Page :1. of 1 • INTORNIATION STATUS: The information in the Notification Renewal Form is: >t- HCAI_T�1 © 1. Unchanged and correct. ❑ 2. Incorrect and altered to reflect the hazardous waste activity of the facility. ❑ 3. Atnmehded to reflect operational chanes of the facility, changes which have occured since the last notification (include attachments if applicable). Note: if adding new treatment units use the Unit Specific Form (1772D). Certification This form trust be signed by all authorized colmrate c07cer or an),other person in the company who has operational control and performs decision-making functions that govern operation of the facility (per title 22, California Code of Regulations (CCR) section 66270.11). All three copies must have original signatures. Waste Minimization I certify that I have it 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 nig which minimizes the present and future threat to human health and the environment. Tiered PermittinL Cerlifluttion 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-, �42enerator 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 assurances by January 1, 1995, and conduct a Phase i environmental assessment by January 1, 1995. I certify under penalty of law that this document and all attachments were verified, corrected, ammended and/or prepared under my direction or supervision in accordance with a system dtSi2ned 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 submittin-, fialse information, including the possibility of fines and imprisonment for knowing violations. Loren Pieper General Managar Name (P int or Type) Title J /lR 3 f 2 R,Lga Signature V Date Signed OPERATING REQUIREMENTS: Please note that generators trewing hazardous waste onsite are required to connph with a number of operating requirements which differ depending on the tier(s) under which one operates. These operating requirements are set forth in the statutes and regulations, some of which are referenced in the Tier-Specific Foctsheets. SUBMISSION PROCEDURES: oYou must submit two copies of this completed notification br certified mail, return receipt requested, to.- Department o:Department of Toric Substances Control Form 1772 RENEWAL Onsite Hazardous Wa.we Treatment Unit 400 P Street, 4th Floor (walk in only) P.O. Box 806 Sacramento, CA 95812-OSO6. You must also submit one copy of the notification and anachmellis to t1ie, local regulatory agenci! in your jurisdiction as listed in the instruction materials. You must also retain a cope as parr rffyour operating record.