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Land Disposal Restriction Notification <br /> Generator Name: CVS*M3C GPA Number Ca.R0nn23'7r2 <br /> Generator Address0632 Pacific AVenUe StoCklor CA <br /> Manifest Tracking Number: 0100768+51-',F <br /> 1nStrUCf10nS <br /> Column 1:List the Mandeet Line number or Manifest Line Bern <br /> Column 2:Idertidy all U S EPA hazardous Waste Codes that appy to this shipment <br /> Column 3:Choose the approprrale treadabdgy group Non-wastewater(NWW)or Wastewater(ww)i <br /> Column 4:Enter the aWolpnate Subcategory(per 40 CFR 268.40) d applicable and aKO enter"Contaminated Sal-or"Debris"d the waste will be <br /> t,+-anted using one of the alternative treatment technologies prnaded by 268 49;C)-soil or 268 45-debris <br /> Column 5: Enter the letter of the appropriate paragraph from belowtsee Appendix 1 for other optrons d needed) <br /> Column 6:For F001-F005,please enter the Reference Numberfsi located below for the consiouents in your waste stream subtect to treatmew <br /> Column 7-For F039.0001-D043 Deb(ts&Cdrnammated Sal please list the Reference Numbers listed in Appendix 2 for any Underlying Hazardous <br /> Constituents <br /> Check One <br /> Now MusD This <br /> Regulate4 Underlying Hazardous <br /> ConstrlueMs <br /> Manifest line Number US EPA Hazardous Sub-Category Waste Be Constituents for D001 encs <br /> or Manifest Line Item Waste Codes Nww ww Managed- For 1`001.1`005 Debris or Sal <br /> 1- 102966 DOD! Yes High TOC Igndao* A <br /> Liquid <br /> Column 5 waste Managernent Codes <br /> THIS RESTRICTED WASTE REQUIRES TREATMENT TO THE APPLICABLE STANDARD This waste musl be treated to <br /> the applicable performance based treatment standard set forth in 40CFR Part 268 Suboart C 268.32.Subpart D 268 40 or <br /> RCRA Section 3004(d)prior to laird disposa! <br /> Column 6 F001-1`005 Reference Numbers <br /> Column 7 DO01 DO43 Reference Numbers <br /> I hereby certify that all information subscribed at this and aft associated documents is compiete and acCur ate to the best of my kno,rriedge and <br /> informallm <br /> Generator Signature: TR 3 <br /> : + <br /> Printed Name. DIM ��, <br />