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Land Disposal Restriction Notification <br /> Generator Name: CVS #109261 EPR Number: CAR000235200 <br /> Generator Address: 100 West Lodi Avenue Lodi; CA <br /> Manifest Tracking Number: 010585. LE <br /> tristructtons <br /> Column 1 : List the Manifest Lina number or Manifest Line item . <br /> Column 2: identify all U .S. EPA hazardous Waste Codes that appy to this shipment. <br /> Column 3; Choose the appropriate trvotatiNty group: Non "Wastewater (NWW) of Waste v er (WW) . <br /> Column 4: Enter the appropriate Subcategory {per 40 CFR 2£8.40) , if appl�a Ie, and also enter 'Contami-hated Soni' or `i3ebris" e the waste Y60 be <br /> treated using one of the alternative treatment technologies proMed by 263 49 (c} soil, or 268.45- debris. <br /> Column 5: Enter the letter of the appropriate paragraph from belaw(see Appendix 1 for other- options if needed) <br /> Column 6: Fox 17001-F005, please enter the Reference Number(s) Wated below for the constituents in your waste stream subjW to treatment_ <br /> Column 7: For F039, D001 tsD043. Debris& Contaminated Sed: please list the Reference Numbers listed in Appendix 2 for any Underlying Hazardous <br /> Constituents, <br /> Check One <br /> Regulated <br /> Underlying Hazardous <br /> How Must This � Constituents <br /> Manfest Lire Number U , S, EPA Hazardous lConstitu to <br /> or Manifest line Item Waste Codes Sub Category Waste Be i For F001 -F005 i lot Chi 1G43, <br /> IJWW WW % Managed? Debris or Soil <br /> ------ - — _ <br /> 1 - 102966 D001 Yes High TOC Ignitable : A <br /> Li <br />