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ENpertSUSTA INASILIT, <br /> Land Disposal Restriction Notification <br /> Generator Name: CWS*09630 EPA Number CAROOQ; <br /> Generator Address: 94632 Pacific Avenue Stockton.CA <br /> Manifest Tracking Number 011387023FLE <br /> Ms&uctfons <br /> Column 1'.List itte Manifest Line number or Manifest Line item <br /> Column 2: Identify all U S EPA hazardous Waste Codes that apply to 00$1`107Ient <br /> Column 3.Choose the approprtabe treatability group Nort-Wastewater iMW V)or Wash weber(WVV) <br /> Column 4:Enter the appropriate Subcategory(per 40 CFR 268.401.0 appacable,and also enter"Contaminated Sod"or Debris 0 the waste will be <br /> treated using one of the alternative treatmern technologies provided by 268 40 ic)-sod,or 268 4S debris. <br /> Column 5:Enter the kites of the appropriate oxagraph from be(ow(sae Appendix 1 fol other options d neooDdl <br /> Column 6:For F001-F 005 please enter the Reference Numberts)IOAW below for the constituents in your waste stream subfect to triealmettt <br /> Column 7-For F039 D001-DO43 Debris&Contaminated Soil please test the Reference Numbers listed in Appendix 2 lot any Underlying Hazardous <br /> Constituents <br /> Check One <br /> Underlyvtg Hazardous <br /> How Must This Regulated <br /> e ldents Constituents <br /> Mari t+st Lxie Number US EPA Hazardous Sub Category Waste,Be it for D001-t7043. <br /> or Manifest Line stent 'Waste Codes Managed? n=or F001-F006 Debris or Soil <br /> rSJYW WW <br /> 9- 102956 1001 Yes High TOC tgnitahtr ; <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 40CFR Pan 268 5tbpail C.266 32.SVbW D 269 40 or <br /> RCRA Section 3004(d)prior to laid disposal <br /> Column 6 F001-FOGS Reference Numbers <br /> Column 7 D001-DD43 Reference_Numbers <br /> I heretry certify that alt rionnation subscribed at this and all associated documents is complete and accurate to the best of my know"a and <br /> m+xrmaiixi <br /> Generator Signature: G�j �ieZ_-z Title: <br /> Punted Name. __ ✓J ����c Date: <br />