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<br /> P.O.Box 24055,MS 702 TRUCKED NON-HAZARDOUS WASTE DISPOSAL PERMIT
<br /> Oakland,CA 94623-1055
<br /> EBMUD (510)287-1336 Fax(510)287-0621 Terms and Conditions
<br /> Page 2 of 2
<br /> REPORTING REOUIREMENTS
<br /> 1. Permit Holder shall provide and require its Haulers and Generators to provide EBMUD,upon request:records,pumping logs,
<br /> manifests or analytical results pertaining to the disposal of trucked non-hazardous wastes authorized under this Permit.
<br /> 2. Permit Holder shall require Hauler to immediately report to the EBMUD Resource Recovery Program any changes to the truck
<br /> information,equipment or operations,or quality or volume of trucked non-hazardous waste which deviate from the Terms and
<br /> Conditions under which this Permit was granted.
<br /> PERMIT FEES AND DISPOSAL CHARGES/ENFORCEMENT AND PENALTIES
<br /> 1. EBMUD reserves the right to revoke a permit for past due payments.
<br /> 2. Permit Holder is subject to enforcement remedies and penalties in accordance with EBMUD Ordinance No.311 A-03,Title VI.
<br /> INDEMNIFICATION
<br /> I agree to defend,indemnify,and hold harmless DISTRICT and its Directors,officers,agents and employees from and against any and
<br /> all loss,liability,expense,claims,suits,and damages,including attorneys'fees,arising out of or resulting from Permit Holder's,its
<br /> generators,haulers,brokers,associates',employees',sub-consultants',or other agents'operation and performance under this Permit.
<br /> CERTIFICATION
<br /> I,Permit Holder understand that I am legally responsible for the disposal of trucked non-hazardous waste and for complying with all
<br /> Terms and Conditions of this Trucked Non-Hazardous Waste Disposal Permit(Permit),and hereby certify that no regulated radioactive
<br /> materials,no materials regulated by Toxic Substance Control Act,and no hazardous waste as defined in Section 25117 of the California
<br /> Health and Safety Code,or any other federal,state,or local statute or regulation shall be disposed. I understand that disposal of trucked
<br /> non-hazardous waste,as described in this Permit,is subject to EBMUD Wastewater Operations Division conditions,EBMUD
<br /> Ordinance 311A-03,and each waste stream proposed to be delivered to EBMUD is submitted on an Addendum A for review and
<br /> approval prior to load delivery to EBMUD. I also agree to maintain the Certificate of Commercial General Liability Insurance
<br /> (Addendum B),Certificate of Commercial Auto/Trucking Liability(Addendum C)and the Certification of Workers'Compensation
<br /> Insurance(Addendum D)and upon any changes or expiration,I will notify the EBMUD Resource Recovery Program.
<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 persons directly responsible for gathering information,the information
<br /> submitted is,to the best of my knowledge and belief,true,accurate,and complete. I am aware that there are significant penalties for
<br /> submitting false information,including the possibility of fine and imprisonment for known violations.Permit may be revoked or
<br /> suspended ifany of these procedures are not complied with.
<br /> 1J�`p Yj ANO `er ��� �'LA -mci,,�
<br /> 1�lAhIE TITLE
<br /> TO I k_ >-Llka
<br /> PERMIT HOLDER-SIGNATURE DATLI
<br /> (To BE SIGNED BY CHIEF EXECUTIVE OFFICER OR DULY AUTHORIZED REPRESENTATIVE. SEE REQUIREMENTS ON REVERSC)
<br /> AUTHORIZATION
<br /> Permit Holder,as described above,is hereby authorized to dispose trucked non-hazardous waste subject to Permit Holder's compliance
<br /> with EBMUD Ordinance No.311 A-03 and the Terms and Conditions of this Permit. EBMUD may amend this Permit during the term
<br /> of the Permit.
<br /> DAVID R.WrLLIAMS,Director of Wastewater Date
<br /> WMEEM
<br /> 4/6/04
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