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Land Disposal Restriction Notification <br /> Generator Name: CVS 00963(' EPA Number <br /> Generator Address ".1-3<Pacific Avenue Stockton,r r, <br /> Manifest Tracking Number: 0O8fi80847FLE <br /> Instructions <br /> Column 1:List ttte Manifest Line number or Manifest _,ne,tem <br /> Column 2:Identvfy all U S EPA hazarda,s tNaste Codes that apply to this stlrpment <br /> Column 3:Cha"the appropriate trealab-tily group Non WastewRlef(NN1N i or'Ovastrwatee i'A'W, <br /> Column 4:EnW the aMroorwe Subcategory(oef 40 CFR 288 40, it appiaabie ano also enter"Contaminated Sou or'Debrisit the waste will tie <br /> treated using one of the alternative treatment technvog e5 pro wteo by 268 49 oe 268 45-deans <br /> Column 6:Enter the letter 0 the approonale paragraph from he see.Append. 1 tot other options d rtewded} <br /> Column fi:For FD01-F005 please enter the Reference Nrumbettsl braMeO beoar for the con5tduents in your wastp stream subWd to treatment <br /> Column 7:For FO39 DOO t D043.De m&Cart arnrnated Snrr ,please Irst the Refarence tJumDers listed in Appendix 2.f r any Urtderilnng"Uardotn <br /> Conattturnts <br /> v �n Must This ttg Undertying Ha¢ardoLis <br /> "landed L,ne Number U S EPA Hazardous .i R ufated <br /> Canstituenta <br /> cr Manttest Line Item Waite Codes SuL c.ategory Haste Be orConstituentsF000 for 13001-0043. <br /> NWA 'A'\N Manaprn" nor FOpi FG05 Debs or Soil <br /> - 102966 DOO vas High`OC gnilable a <br /> L riuid <br /> Column 5 Waste Management Codes <br /> A THI5 RESTRICTED WASTE RFUUIRES TREAT klE NT 7,3 HE; Haat C VBLF .STANDARD Thos waste must be treated to <br /> the 410011c3ble performance baser,treatment standard 5W t^rth it,40C:PR Fan %Subtan L. :68 3Z Subpat 1268 4a! r <br /> R.CRA Senior 3004tdi prior to land otsposal <br /> Column 6 F001-FOGS Reference Numbers <br /> Column 7 0001-0043 Reference Numbers <br /> hereby certaty that ail;nfofnialior sut:grnte;al ii,,%a,vj ail assor:,ated dMuments is Cvnipi*.ge and a;r-urate to the best M my knoivWge ano <br /> ir+f.•mot�nn <br /> Generator SiSlnature: �~ti 1- Lr ryn <br /> Title: <br /> Printed Name: 1'` v 1 /^ <br /> Date: <br />