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Land Disposal Restriction Notification <br /> Generator Name: CVS 909830 EPA Number. CAR000231712 <br /> Generator Address. 6632 Pacific Avenue Stockton,CA <br /> Manifest Tracki"Number- 008570609FLE <br /> Instructions <br /> Column 1:List the Manifest Line number or Manifest Line item. <br /> Column 2:Identify all U-S.EPA harantous Waste Codes that apply to this shipment- <br /> Column 3:Choose the appropriate treatability group Non-Wastewater(NW W)or Wastewater(WW), <br /> Column 4-Enter the appropriate Subcategory(per 40 CFR 268.40),if applicable,and also enter'Cantaminated Scil`or-Debns-if the waste will be <br /> treated using one of the altemalive treatment technologies provided by 268.49(c)-soil,or 268.45`debris- <br /> Column 5:Enter the letter of the appropriate paragraph from bolow(sec Appendix 1 for other options if needed) <br /> Column 6;For F001-F005,please enter the Reference Number(s)located below for the constituents in your waste strrarn subject to treatment. <br /> Column 7:For F039,D001-D043,Debris&Contaminated Soil:please fist the Reference Numbers fisted in Appendix 2 for any Underlying Hazardous <br /> Constituents. <br /> Check One <br /> Regulated Underlying Hazardous <br /> !Manifest Line Number U-S.EISA Harrdous Haw Must This Constituents <br /> Sub-Category Waste Be Constituents for D001-0043, <br /> or Manifest Line[tern Waste Codes N W W W'7J Managed? For F001-F005 Debris or Soil <br /> 1 -100196 D007,D010 Yes A <br /> 2-102964 D009 Yes High Mercury A <br /> Inorganic <br /> 3-103446 13007,13010 Yes A <br /> 4-101079 P00l Yes A <br /> 5-103445 13009,13024,U129,1_120 Yes A <br /> 5 <br /> 6-100201 D001 Yes Ignitable A <br /> Charectoistic <br /> waste <br /> 7-100800 D007.D010 Yes A <br /> 8-100198 D00l,U002 Yes High TOC lgnitable A <br /> Liquid <br /> Column 5 Waste Management Codes <br /> A THJS RESTRICTED WASTE REQUIRES TREATMENT TO THE APPLICABLE STANDARD.This waste must be treated to <br /> the applicable performance based treatment standard set forth in 40CFR Fart 268 Subpart C,268.32.Subpart D,263-40 or <br /> RCRA Section 3004(4)prior to land disposal. <br /> Column 6 F001-F005 Reference Numbers <br /> Column 7 0001-D043 Reference Nembers <br /> I hereby certify that all infortmatio `bed at this and all associated documents is oomplete and accurate to the best or my knowledge and <br /> information. <br /> Generator Signature_ x Title: <br /> Printed Name: /` Date: <br />