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+ , i � o f � l 6; <br /> / _ � TSS C '.0�4 4�.`h Q'�3-i+ �',�` -�• <br /> t a ,; l✓"} Fonn Ap"ploved.OMB No.2050-0039 <br /> Tease print or types(Form'designed for use omelite'(12 pitch)typewriter,) .- /.__. <br /> t 'UNIFORM WASTE MANI HAZARDOUS 1 Generates ID Number r 2.Page 1 M 3'Emergeluy Response Phone 4.Manifest Tracking Number }4 ; ;•; <br /> _ JJK; <br /> 5,Generator's Name and Maigng Address _ s SheAddress(1different than maling address) ,•. . '.a:+ <br /> ''Pod Of 08{t and <br /> FOfrliBt O81d8ftdAfTl�y 639 101!1 i bt8rfit91B <br /> 530 WsWr Street604 <br /> Us148ttti,.CA.A4>1�7'QB-4866' <br /> G-nWXLj,�A 94 <br /> P.Transporter 1 Company U:S.EPA ID Number r <br /> 7.Transporter in*P.R.aft0q,he U S:EP I um <br /> 8:Designated Facility Name and Site Addrese _. .. •_- -- <br /> 'U.S.FPA ID Number <br /> WS Hw Rwd Lendfii) f--- cAoeazoazar ' r <br /> 6426 Reed <br /> VercovH .CA.9588t L : • _. - _ - <br /> Facility's Phone: , <br /> 94.U.S.'DDT Description(mdrrdng Proper Sf)grping Narire,,Hazard Class ID NurnW, :'10:Containers <br /> �.: 11:Total 12 Umt' <br /> HM and??cldr!g (d any)). No. Type Quantity Wt1Vol•. 13:Wasb Codes <br /> eS <br /> p X` 1 <RO 'ASBESTOS 8 NIA�41Z PG RI J� AL y <br /> 2 2 <br /> 'L ,1.�. ♦ ✓ !:J t�rht Z i n/ 9! - t + ' ',..'-L tj l„ Ey` \ v5 f 3 <br /> r <br /> .,., .. .. :.. ..... ".. .... ...0 ..«....'..•:+..1:G .'......_«.... .•rY.r+.'A'.••'riif',.+....i.Yf-• �•:�4. ,a.}. , w P.:. ..1 t{i.Y.f.i ' <br /> "� t Ytil <br /> i 3. ': N •t i f r f • <br /> us <br /> ..f}H� 'Jt <br /> if,` l., L - .. r' ..•. .-ate:'S. y 1' <br /> arY- <br /> 14.Special Harrdting Ini tnuuons and Additloi Inronra0an <br /> ,ASBESTOS MGM7..CROUP'OF CJ►,lNC..;3438 HELEN STREE t:OAKLAND.CA 94608 <br /> "BAAf�MD 939 ELU6 ST,SF,CA-(415).771-6000 Eh6ERGENCI'RESPONSE(31©)854-84 <br /> k 'AS8E5TOS REMMAL REOLIREMMS40 CFR 61(SAGGED SEALED 8 LABEiFD)EPA FiEG10N0(,:`. <br /> 15..GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of thus cnnsigrmhenI are fully and accurately described above by the proper shipping name,and are classified,packaged <br /> marked and labeled/Placarded.and are in all respects in proper condition for transport according to applicable international and national governmental regulations.K export shipment and I am the Primary <br /> Exporter,I certifY that the contents of this consignment conform to the terms of the attached EPAAdmowtedgment of Corrserht . <br /> 16m*that the waste minimization statement identified in 40 CFR 28227(a)('d I am'a large quantity generator)or(b)(-dl am a small quantity generator)is-true. <br /> Gerreratoesl08erar's Printed/Typed Name Signature i Mmdh Day Year'. <br /> oNGu�o . <br /> -, NY (� <br /> J 16.In emational shipments t <br /> 0 import m U S. sa E, mt kom uS '.P,at of eribyrexit <br /> Transporter signature(for exports Doty).' ' Date leaving U.S <br /> 17.Transporter AGoto dedgment of Receipt of Materials <br /> T 1, yped Name ) t ... <br /> Year <br /> e. <br /> Transporter 2 Printed/Typed Marne <br /> �. <br /> Day <br /> f <br /> ! �✓ Month Y <br /> ,i <br /> 18.Dsaepanry.. <br /> t <br /> 18a Drsaep&wy ktdratwn Space <br /> a. o.T . <br /> o -' Residua'' Partial Rejection Ful Rajediod <br /> 18b.Altemata F or Generator),. - , <br /> _. _- ... <br /> .Atattilest Reference Number. <br /> ,, U;S.EPA ID Number - <br /> ua. Facill"Phone: <br /> �-18c:SlgnahaaorAltfertrerFtto�hty(wGenerattu)----.- -^ ... .:- -:�,-�-...-:--•----- Mdidh":--Dail Year""-- <br /> Z . <br /> 19.Ftazardmrs YVaste:Repott Management Method Codes(i.e:codes for:ffarardrna waste freaknent disposal.and recyang systems), . ,«• y. .r <br /> 13, 4.,. <br /> ti f '' ".' . <br /> 20 Des' d Facility r or Operator.Cefff adon at receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Prmted/T /_ <br /> Signature \ ear <br /> h e .orf+. 11Y you <br /> EPA Fotm 87 (Rev Previous ediibons are bbsole :, <br /> R <br /> > :DESIGNATEDfEAcm- GENERATO <br /> ::x' 10285.2053 <br />