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State of California—Environmental Protection Agency Form Approved OMB No.2050-0039(Expires 9.30.99) See Instructions on back Of - '+e 6. Department of Toxic Su6stan s � I Please prrnt or type. Form designed For use on elite(12-pitch)t, for. SacramentoCaIif , orn UNIFORM I IAZARDOUS 1, GeMfator's US EPA ID No. Manifest Document No. 2. Page I Information in the shaded areas WASTE -IAZ (FEST ; 1 qm,r ;:.., A p ❑❑; f� C (� t1 is not required by Federal law. C A L 010101 1 8 Cl '3191 V G 0 C1 5 of 3. Generator's Name and Mailing Address r A. State Manifest Document Number r�e� /� C.S.O. STANISLAUS s 23534720 1252 NIURTH STANISLAUS B. State Generator's ID ' A. Generator's Phone STOCKTON CA 95267 !V 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] - � t WORLD EWIROME.NTAL. AENERGY ', 0101 a, 3 1112, A I a D. Transporter's Phone OD 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporters ID Reserved.] VQ F. Transporter's Phone 9. Designated Facility Name and Site Address 10. US EPA,1p Number G. State Facility's ID ctg ivlaj l� Roca tiQhdF1 Pi 06140 A64ArMTTn'T'V—'r1M-17 c R 09' 9 20 yZ i H. Facility's Phone �707 4WI—3 V-6' V)—Q 12. Containers 13. Total 14, Unit 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) Mu s-< No. Type Quantity Wt/Vol I. Waste Number ra-) ASBESTOS, 9, NAr`'212, FK:i11I(NA1RGy#17i ) state 151 t- - G EPA/Ot er o N 6. State o°Do E R EPA/Other 4 A C. State o T a8o O R EPA/Other • w `d. State Z w V EPA/Other LU N !. AdditioiiaT,,Destttption,s for Materials Listed Above K. Hpoling Codes for Wastes L steel Above m Z b. tn LU X8BE9Tb6-CnNV1NING MATERIAL Q C. a. Z 15. Special Handling Instructions and Additional Information 0 < 24 HOL)RS EMERGENCY # (%6)373.-361-7.E.F•1A RE:GIDN 1X.LPA RE61ON IX REGION Z IX BAAGMD 939 ELLIS ST SAN F'RANCISC0 CA,941 9 ASPESTOS REMOUAL. hFb1.TREMENT w 40tF-R61, (11AC;IED SEALED I-PRE'LED) Job Name: C.S.b. STANIFA..AUS Job # 5195 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, Umarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. J If I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically o practicable and that I have selected the racticable method of treatment,storage,or disposal currently available m which minimizes the present and future threat to human health and the environment;OR,if I am a sma I quantity generator,I have made a good faith effort to minimize my w Ste g neration and select the best waste management method that is Oavailable to me and that I can afford. Pri ed/Typed Name -,N, Month Day Year Z tit OS15 2 ©I `l olU w T 17. Trans o ter 1 Acknowledgement of Receipt of Materials R W A Printed/Typed Name Signa a Month Day Year R Lf� Z w S LL- -t?._ 18. Transporter 2 Acknowledgement of Receipt of Materials 0 RRT Printed/Typed Name Signature Month Day Year LU E R U19. Discrepancy Indication Space Z F i `tA r C i L 20. Facility Owner otfoperator Cirtijfca of cei of llvzordfustnoterials covered 6X,Vs ma fe ce in Ite / i / ant Da Year T Printed/Typed Name / Signature Y Y `� l,' - I L/L i DO NOTWR /BELOW T S LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. 22A(1/99) (Generators who submit hazardous waste for transport out-of-state, DISC 80 EPA 87022A produce completed copy of this copy and send to DTSC within 30 days.)