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Land Disposal Restriction Notification <br /> Generator Name, 99 Cents Only*177 EPA Number- CAL0003G9945 <br /> Generator Address: 1420 E.i-lam ner Lane Strktean,CA <br /> Manifest Tracking twvmber 013692125FLE <br /> h7sbtICffons <br /> Golurnn 1:List the Manifest tine number or Kwifest Line FLm. <br /> Column 2:Identify ail U.S_EPA hazardous Waste Codas that apply to this s#eiprnerd. <br /> Column 3.Choosethe apprapriattetneata ility group:Norr-Wastew W{RMWV or Wasbmater i'NW} <br /> Column 4:Enter the aXrgw-W a Subcategory(per 40 GFR 268.40), if appdicabla, and alsw Saiz'or-Ge 'if the waste will be <br /> tm.ated using one of the plt0rraei vo trwtrnerrt to chr�ologies pmNided by 268.49{c}-sol,or 265.45-debris. <br /> Column 6'Enter the letter of the appfoprialepragmph SrOrn below(see Appendix 4 for otber options if needed) <br /> Cofurnn 6:For F601-Ft}p5,please enter the Referenoe Number(s)located 4e1ow for the constituents in your waste stream subject to trevrne nt. <br /> Gofurnn 7:For FCM.5)041-5)44.3, debris&Cprrtarnr nigled$pit plea"list the Reference Numbet3 listed in Appendix 2 for any Underlying Ha¢ardoUs <br /> Constituents. <br /> Check One <br /> Regulated Undedying Hazardous <br /> Man9fest Line Nurnber Q.S.E<PA Hazardous Hahv r4iLst�h�s Cowtduents. <br /> or Manifest Lincs Item Waste Codes SuG Ca#acory Wn%De or F0 tie OOs. f0f 1 007-1)043, <br /> N4V 1hfW <br /> Manag8r For FOtYI-F005 Deb(%or SiSl <br /> 1-144998 D001 Yes lgnita41b A <br /> Gharecteristic <br /> Waste <br /> C NuFon 8 Wn5te Management Codes <br /> A T RIS RF STRICTPI)WASTE RFQU1Rrz TRF-A iMEN-F TO THE APPLICABLE STANDARD.This waste niust be 7reate d to <br /> the appficatile performance ioarsed tf An*flt standard set forth in 40CPR Pam 268 SubpW C.258.32,Subpart D,268,46 or <br /> RGR A St3Gbm 30D4(d)prior to land disposal. <br /> Colum nb FOOT-FOUS R2ferenze Numbers <br /> Column 7 DOQi-D043 Reference Numbers <br /> 1 hweby cwV'y that all.ink rnation subscr bW at this and all associated docurr.erts is oornnlete and accurate tathe best of my knowledge and <br /> infgrma3ipn. <br /> Generator Signature: � f 7It16' fG <br /> P'rintad Nam: ___ ]I 2 r� _ ,/. F":' � data: <br />