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Land Disposal Restriction Notification <br /> Generator Name: CVS#09830 EPA Number, CAR000231712 <br /> Generator Address: 6532 Pacific Avenue Stockton,CA <br /> Manifest Tracking Number: 010788941 FLE <br /> Instructions <br /> Column 1.List the Manifest Linc number or Manifest Line item. <br /> Column 2:Identify all U.S.EPA hazardous Waste Codes that apply to this shipuzent <br /> Column 3:Choose the appropriate treatability group:Non-Wastewater(NWW)or Wastewater(WW). <br /> Column 4:Enter the appropriate Subcategory(per 40 GFR 258.40),if applicable,and also ender"Contaminated Sar or"Debris"if the waste wM be <br /> treated using one of the altematirve treabyowt technologies pruAded by 268.49(c}soil,or 268.45-debris- <br /> Column 5:Enter the letter d the appropriate paragraph from below(see Appendix 1 for other options if needed) <br /> Column 6:For F001-F005,please enter the Reference Numbers)located below for the constituents in your waste stream subject to treatment- <br /> Column 7:For F039,D001-0043,Debris&Contaminated Soil:please list the Reference Numbers listed in Appendix 2 for any Underlying Hazardous <br /> Constituents. <br /> Check One <br /> R ulated Underlying Hazardous <br /> Manifest Line Number U.S.EPA Hazardous <br /> How Must This stituents Constituents <br /> or Manifest Line Item Waste Codes Sub-Category Waste Be For Fool -F005 for D001-13043, <br /> Nww ww <br /> Managed? Debris or Sal <br /> _ <br /> 1-102966 D001 Yes High TOC IgnitaNe 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 40CFR Part 268 Subpart C,266.32,Subpart 0,258.40 or <br /> RCRA Section 3004(d)prior to land disposal. <br /> Column 6 F001-F005 Reference Numbers <br /> Column 7 D001-D043 Reference-Number$ <br /> I hereby certify tl-�at all informa'w' Fulwn.Md at this and all associated documents is complete and accurate to the best of my knowledge and <br /> information. <br /> a <br /> Generator Signature: 1 t Title: ` <br /> Printed Name. �t /i7.t��t L�' Gate: <br />