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NOV 29 100 03:45PM TYCO'tTOCKTON 2094660530 P.2 <br /> CONFIDENT <br /> State of California-CalBomla EnWronmentel Proteetlon e D artment of Toxic Substances Control <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> ' HAZARDOUS WASTE <br /> CERTIFICATION OF FINANCIAL ASSURANCE <br /> FOR PERMIT BY RULE AND CONDITIONALLY AUTHORIZED ONSITE TREATERS <br /> son <br /> e. WE"All Cettinc idon b. Amended C"AR90A IN o. Annual Certification 5 <br /> 1.FACILITY IDENTIFICATION tNlmremxa aaml.nmmpnmimNe.vaue oro aIm) <br /> BUSINESS NAME Itmne.s FACILrrY NAWW DBA-Dgaa Bw1aW M) <br /> Tyco Electronics, Printed Circuit Group, Stockton Didision <br /> FACRsITY We I FACD.ITY BPA 1D# <br /> CAD109227496 <br /> TYPBOFOPBRATION w PBR-FTU ❑ b. CA ❑ G. Otho ml <br /> IL ESTIMATED CLOSURE COSTS <br /> NOTE'., In addition in the dollar,figure below a wriffm e,dmate of eloeure enter mutt be affaebed when you.submit this rection ofµis page. <br /> 6sTWATEDCLOSURBCOSTS S 7.548.60 TMs <br /> III. EXEMPTION FROM FINANCIAL ASSURANCE REOUIREMENTS <br /> I. i em not required in provide a mechanism hccamce <br /> L•3 a. I certify War my closure cost estimate is less than or equal to S 10,000,or av <br /> lrn <br /> ❑ b.' Specify other reasons <br /> ❑ d. As a PBR owner m operator,l have not operated mora Own thirty days in a oaloodar your. (Dan non apply to Canditional Au hm(saton) 'm5 <br /> 1V. CLOSURE FINANCIAL ASSURANCE MECHANISM <br /> ❑ 1 nn requirrod to provide a mechanism and It is atwehed to this me. i0° M6CFG NLSM W MfbfBBR(S): <br /> 6FFBCTIV6 DATE OF CLOSURE ASSURANCE MECHANISM <br /> MSCHANISM TYPE ❑ v Closure Trust Fund ❑ d. Closure Incursion; ❑ g. Multiple Financial Machenisrna s <br /> (~M.v iemmvy) ❑ b. Surety Bond ❑ a Ffnatseial rest and Corporate Guarantee ❑ IL Carlincate of Deposit <br /> 0 c. Closure Letter of Credit ❑ f. Alocrind a Mcohanism ❑ i. Savings ACCeenL <br /> FINANCIAL INSTITUTION,INSURANCE OR SURETY COMPANY/OTHER OROANMATION rlo <br /> ADDRESS N <br /> CrPY sla STATE she ZIP CODE 714 <br /> V.OWNER OR OPERATOR CERTIFICATION <br /> SIUNER Op TInS CBRTR'ICATION ❑ a. Owner Xb. Opera= 'la <br /> I ecrtiN under penalty of law that Nis document and aB ouachmenw were prepared under my dlreedon or mpervitioa in accordance with a system designed to assure tMh <br /> quallSed personnel properly gather and evohwse the information submitted. Basod on my inquiry of the person or persons who matrusge the system,or those directly <br /> respuntibia for gathering the Information,the information is,b the best of my knowledge and belief,Due,accurate and complete. I am aware Was then are sigrdll<erd <br /> perishes for submitting falx inPormstion,including the possibility of fines end imprisonment for knowing violations. (22 CCR§66370.11) <br /> SIUNATURE OFOBPJ70 0RATOA.�r� DATE sin <br /> 11-29-00 <br /> � <br /> NAME 6f OWNBWOP6RATOR(urine) fir <br /> TITLE OF DWN6NOPBRATOR is <br /> Lloyd Finley Manager Environmental Affairs <br /> UPCF(12/99) 35 Formerly DTSC 1232 <br />