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Land Disposal Restriction Notification <br /> Generator Name; 99 Gents Only#11T7 EPA Number, CAL000369845 <br /> Generator Address' 1120 E.Hammer Lane Stockton,Cp, <br /> irlanife.tTraclting Number_ 014U27410F11.' <br /> lastmeffons <br /> Cadtarnn 1:List the Manifest Line nurrrher ar Manifest Line item. <br /> Column Z-.Identify ati U-3-EPA hazardous Waste Cr that apply to this shiprmxg. <br /> Colurnn 3.Chose the arpprop6*be t wtrborty group:Non-WastewaW(NAW)or Wastewater{WW}. <br /> Column 4-Enterl}ts apperriste Subos#egary(per-40 CFR 268-40),if applicable,sr4 8154 enter'Contaurrinated;toil"or Debris'if the waste wiu be <br /> b6abed using am of the alternative troatrr at tecbnologies provided by268-49(c)-sail,or 260.45-creb+is, <br /> CcAumn 5 Enterthe ietter of the appropriate pama raph from be"5,ae Appendix 9 for ofhar options if needed) <br /> Gafumn 6,For 1`001-1`005,paeaseenter the Reference Number(s)Iccated belowfor the consti€uenfs in your VAMn stream subject to jeoubnent. <br /> lraiumn 7:For F039,DWI-0043,❑ems$Cwitamirk-AF_d Sca:pkeasc list the Reference Numt>m listed in Appendix 2 for any Urtdertyirtg Haza*ws <br /> CQU56tuents- <br /> Check One <br /> tiow Mxvst This Regulated Underlying Hazardxws <br /> IuTaaiifest Line dumber Ll- , EPA I�azardcus Constituents Constituents <br /> or Ma;-Omt tine Item Waste Cedes Sx 4 Category WasL�Be For 1`041-F005 for M01-D043. <br /> I�VV VV V4 W Managed? Debris or a0il <br /> Column 5 Waste Managentgrlt Codes <br /> Column 6 F001-FOGS Deference Nura'bom <br /> Column 7 D001-15043 Roferenoe Numbers <br /> I hereby cenrfy that all irlfowrRAiw subscnbad at this and all msocWed documents is complete and aecurare!o the best 4if my imoWedge and <br /> infomiation. <br /> 6Y � <br /> Generator Signature= <br /> Printed Name: uatm <br />