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E r* LISTQ NABILITy" <br /> � «, di:;. Land Disposal Restriction Notification <br /> Generator Name: Dollar General#14130 EPA Number: CAL000376262 <br /> Generator Address: 4115 N EL DORADO ST STOCKTON,CA <br /> Manifest Tracking Number: 012121140FLE <br /> Instructions <br /> Column 1:List the Manifest Line number or Manifest Line item. <br /> Column 2:Identify all U.S.EPA hazardous Waste Codes that apply to this shipment. <br /> Column 3:Choose the appropriate treatability group:Non-Wastewater(NWW)or Wastewater(WW). <br /> Column 4:Enter the appropriate Subcategory(per 40 CFR 268.40),if applicable,and also enter"Contaminated Sal"or"Debris"if the waste will be <br /> treated using one of the alternative treatment technologies provided by 268 49(c)-sal,or 268.45-debris. <br /> Column 5:Enter the letter of the appropriate paragraph from below(see Appendix 1 for other options if needed) <br /> Column 6:For F001-1`005,please enter the Reference Number(s)located below for the constituents in your waste stream subject to treatment. <br /> Column 7:For F039,D001-D043,Debris&Contaminated Soil:please list the Reference Numbers listed in Appendix 2 for any Underlying Hazardous <br /> Constituents. <br /> i � I <br /> Check One _ <br /> � _ ------- Underlying Hazardous <br /> Manifest Line Number 1 U.S.EPA Hazardous How Must This Regulated Constituents <br /> Sub-Category Waste Be Constituents for D001-D043, <br /> or Manifest Line Item Waste Codes Managed? For F001-F005 <br /> NWW ; WW i Debris or Sal <br /> 1-110517 <br /> - DI pO2 _- - � -- A <br /> i-- 1-Y - - - T - - <br /> Column 5 Waste Management Codes <br /> A JTH$S RESTRICTED WASTE REQUIRES TREATMENT TO THE APPLICABLE STANDARD.This waste must be treated to <br /> the applioabie performance based treahnent 5UrdWd get forth in 40CFR Psrt 268 Subpart C,268.32,Subpart D,268.40 or <br /> RCRA Section 3004(d)prior to land disposal. f <br /> Column 6 1`0014005 Reference Numbers <br /> Column 7 D001-D043 Reference Numbers <br /> I hereby certify that all information subscribed at thWiand all associated documents is complete and accurate to the best of my knowledge and <br /> information. <br /> V <br /> Generator Signature: Title: 1 LSA'/ <br /> Printed Name: 1 I Date: ,/ Ile' <br /> ' <br />