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Land Disposal Restriction Notification <br /> Generator Name: CVS it09830 EPA Number: CAR000231712 <br /> Generator Address: 6632 Pacific Avenue Stockton,CA <br /> Manifest Tracking Number. 009156013FLE <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(W W). <br /> Column 4:Enter the appropriate Subcategory{per 40 CFR 268.40),if applicable,and also enter"Contaminated Sail"or"Debris"if the waste will be <br /> treated using one of the altemative treatment technologies provided try 268,49(c)-soil,or 268.455-debris. <br /> Column 5:Enter the letter of the appropriate paragraph from bdow(see Appendix 1 for other options it needed) <br /> Column 6:For F001-F005,please enter the Reference Number(s)located bekxv for the constituents in your waste stream subfcct to treatment, <br /> Column 7:For F039,D001-Do43,Debris&Contaminated Sal:please Inst the Referenoe Numbers listed i5-.Appendix 2 for any Underlying Hazardous <br /> Conshwh tints, <br /> Check One <br /> R �� Underlying H2Constituent-, <br /> Manifest Line Number U.S.EPA Hazardous How Must This e9 Constituent; <br /> or Manifest Line item Waste Codes Sub-Category Waste Be Constituents for D001-D043, <br /> NWW WW Managed? Fw F001-F005 Debris or Sal <br /> 1-102966 DO01 Yes High TOC Ignitable A <br /> Liquid <br /> Column 5 Waste Management Codes <br /> A THIS RESTRICTED WASTE REQUIRES TREATMENT TO THE.APPLICABLE STANDARD.This waste must be treated to <br /> the applicable performance based treatment standard set forth in 400FR Par'258 Subpart C,268,32,Subpart D.268.40 or <br /> RCRA Section 3004(d)prior to land disposal. <br /> Column 6 F001-F005 Reference Numbers <br /> Column 7 D001-DD43 Refe'renue Numbers <br /> I hereby certify that all information subscribed at this and all associated documents is complete and accurate to the best of my knowledge and <br /> infcrrnaton. <br /> Generator Signature: 7� Title ).bY` `� �\s'••\L <br /> Printed Name: Date: £+4 i-- <br /> i <br />