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Expert SUSTAINABILITY <br /> Land Disposal Restriction Notification <br /> 3Pncratr,;r Name: CVS 009831.-' EPA Number. CARD00231 T12 <br /> Generator Addr088: 6632 P&1iv Avt'rtue LA <br /> Manifest Tracking Number: 008675457FLE <br /> Instructions <br /> Column 1.us!!ne Ma-,,fes:une number or Ma-1,fes!L•ne dem <br /> Column Y:Identify alt U S€PA hazardous Waste Codes that apply to this sn,pment <br /> Column 3:Choose the appropriate trealan lrty group Nor-Alastewater lNVVW,or Wastewater(W"W <br /> Column 4;Enter the appropriate Subcategory Iper 4C CFR 268 401 r"applicable and also enter Contarrrnated Salor 'Debris �t the waste wit oe <br /> treated using one of!ne aaemat ve treatment tecnnorog,es prov sled by 268 49 1 c: -soil or 2fi6 4, debris <br /> Column 6:Enter the letter of the aeoropnate paragraph r+om befowisee Appendix 1 far other options f needed <br /> Column 6:For F001-FOO5 please enter the Reference Number;s)located below for the constituents in your waste stream subject to treatment <br /> Column 7;For F039 DOOI-DO43 Dews&Contaminated Soil please!ist the Reference Numbers listed in Appendix 2 for any Ur derlyrng Hazardous <br /> Constituents <br /> CeeCk' C r e <br /> Regulated Underyn'g Hazardous <br /> Manifest Line Number US EPA Hazardous Hutiv Must This Constluents <br /> or Manifest Line!tern Waste Codes Suo-Category Waste Be Constituents for 1)401.0043 <br /> 'JV <br /> NWv^::^,r <br /> Managed? For 1`001-FpOs Debris or So+! <br /> t - 103446 D007 DO10 Yes <br /> 2 100198 0001 U002 Yes High TOC Ignitable A <br /> L,qura <br /> Column S Waste Management Codes <br /> A TH!S RESTRICTED WASTE REQUIRES TREATMENI TO THE APPLICABLE STANDARD This waste must be treatise to <br /> the applicable performance based treatment standard set"h in 40CFR Part 268 Subparl C 268 32 Subpart D 268 40 or <br /> RCRA Section 3004{d)prior to land disposal <br /> Column 6 F00'-1`005 Reference Numbers <br /> If <br /> Co umn 7 D001-1)043 Reference Numbers <br /> I hereby certr!y that all mforrnetron subscribed at this and al'associated docurnents;s complele and accurate to the best of my knowledge and <br /> rt c.r�atiOn _ <br /> Generato*Signature: �' Title: !� V[� <br /> fe l ~4,,` <br /> Plwted Name. ?[}n eir1r / / <br /> ze / - D W1f <br /> Gate: ! <br />