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EXPertSUSTAINABILITY <br /> Land Disposal Restriction Notification <br /> Generator Name: Dollar General#13592 EPA Number: CAL000373076 <br /> Generator Address: 310 W DR MARTIN LUTHER KING JR STOCKTON.CA <br /> Manifest Tracking Number: 010685516FLE <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:Enler the appropriate Subcategory(per 40 CFR 268.40),if applicable,and aiso entef"Contaminated Sail"or"Debris"if the waste will be <br /> treeled using one of the abtemative treatment technologies provided by 268.413(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 FOO 1-FD05,please enter the Reference Numbers)located bektw for the constituents in your waste stream subject to treatment. <br /> Column 7:For F039,D001-DD43,Debris&Con laminated Soil;please list the Reference Number;listed in Appendix 2 for any Underlying Hazardous <br /> Constituents. <br /> Check One <br /> - ' Underlying Hazardous <br /> Manifest Line Number U.S.EPA HazardousHow Must This Regulated <br /> Constituents <br /> or Manifest Line Iter, Waste Codes Sub Category Waste Be Cvnstduents <br /> NWW WW Managed? For F001-F005 for D001-D043, <br /> Debris or Sal <br /> 1 1(0544 D009 -- Yes <br /> Low Mercury A <br /> Inorganic <br /> 2-110515.._ D042 �_-Yes - A - <br /> 3-110541 0001 =Yes - H Igh70C 1$n$abie i A <br /> - - - — -) — Lrquld — <br /> Column 5 Waste Management Codes <br /> THIS RESTRICTED WASTE REQUIRES TREATMENT TO THE APPLICABLE STAN11 DARD.This waste must be 1.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"'b <br /> tq, Title: r <br /> Printed Name: L( t J_�JCS U <br /> - Date: <br />