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E xpert SU STAINABILITY <br /> Y..4 1-- land Disposal Restriction Notification <br /> Generator Name: CVS 009830 EPA Number. C.AR000231712 <br /> Generator Addrmw Jb32 Pacific Avenue StOCwlnrl CA <br /> Manifest Tracking Number. 010076417FLE <br /> Instmclions <br /> Column 1:USI the Mantling Line number or Mandell Lane eam <br /> Column 2:identity d U.S.EPA hwardous Waste Codes that apply to this shipment <br /> Column 3:Choow. the amopnate Insalabiaty groupNan-WMumoler(NWW)or Wastewater(ww) <br /> Column 4:Enter the atrwoprrate Subcategory(per 40 CFR 258 40),it appkible and also enter'Contam+nered Sod'or"Debris'd the waste wnU be <br /> treNed using ane of the attonahve trttatrneM technologies provided by 268 491cMoIr or 268 45-debns <br /> Column 5:Enter the letter of the appropriate paragraph from beluMsee Appendix 1 fa other optons d needed) <br /> Column 6:For F001-F0OS,piame estter the Reference Number(*)kwAsd betoaar for the constituents in your vvra*1e atrienl su9 W to trgdnMh t. <br /> Column 7•For P039,DOOI-DU43 DebnsE Corkernrnated Soil please let the Reference Numbers listed in Appendix 2 for arty Underlyting hazardous <br /> Constituents. <br /> Chea: One <br /> How Must This Ragulailed Underlying Hozard0us <br /> Mandest Line Number U S EPA Hazardous Comflit"fs C <br /> oromuwft <br /> err Mandest lane Item Waste Codes Sub-Cat Waste Befor <br /> y Managed? For F1?01-F005 D�1a Shod <br /> NWw WW <br /> 1- 100196 0O07.13010 yes A <br /> Column 6 WaaOe Menagen"M 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 font)In 40CFR Part 258 Subparl 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 /> C mn 7 0001-0043 Reference Numbers <br /> I hereby certify that all information subscribed III assoc>ated documents is complete and accurate to the test of my knowledge and <br /> information V ff <br /> /J <br /> Generator Signature: TIW <br /> Printed Name; Date: <br />