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ExpertSUSTAINABILITY <br />Land Disposal Restriction Notification <br />Generator Name: Dollar General #13632 EPA Number: CAL000373074 <br />Generator Address: 2907 E. WATERLOO ROAD STOCKTON, CA <br />Manifest Tracking Number: 010685515FLE <br />Instructions <br />Column 1: List the Manifest Line number or Manifest Line item <br />Column 2: Identify all U S. EPA hazardous Waste Codes that apply to this shipment. <br />Column 3: Choose the appropriate treatability group Non -Wastewater (NWW) or Wastewater (WW). <br />Column 4: Enter the appropriate Subcategory (per 40 CFR 268.40), if applicable, and also enter "Contaminated Sal" or "Debris" if the waste will be <br />treated using one of the alternative treatment technologies provided by 268.49 (c) -soil, or 268.45- debris. <br />Column 5: Enter the letter of the appropriate paragraph from below(see Appendix 1 for other options if needed) <br />Column 6: For F001 -F005, please enter the Reference Number(s) located below for the constituents in your waste stream subject to treatment. <br />Column 7: For F039, D001 -D043, Debris& Contaminated Soil please list the Reference Numbers listed in Appendix 2 for any Underlying Hazardous <br />Constituents <br />Check One <br />Underlying Hazardous <br />Manifest Line Number p U.S EPA Hazardous How Must This Regulated Constituents <br />or Manifest Line ItemWaste Codes Sub Category Waste Be Constituents for D001 -D043, <br />NWW WW Managed? I For F001 -F005 Debris or Soil <br />1 - 110518 D001 Yes High TOC ignitableA I <br />E _ j Liquid ' <br />2-110541 D001 Yes i High TOC Ignitable' A <br />I I Liquid <br />3-110515 D002 Yes A <br />4-110544 D009 'Yes Low Mercury A _ ......, . <br />Inorganic <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, 268.32, Subpart D, 268.40 or <br />RCRA Section 3004(d) prior to land disposal. <br />Column 6 F001 -F005 Reference Numbers <br />Column 7 D001-DO43 Reference Numbers <br />I hereby certify that all information subscribed at this and all associated documents is complete and accurate to the best of my knowledge and <br />information. <br />Generator Signature: ✓"l'� V>C Title:S- <br />/ <br />Printed Name: (7 C o Ir t�/1- (�� Date: <br />