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Please print or type.(Farm designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000013863 1 (800)359-4555 1007335808 JJK <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> Stockton Unified School District Edison High School <br /> 1944 N. EI Pinal Drive 1425 S.Center Street <br /> Stockton CA 95205 Stockton CA 95206 <br /> Generators Phone: 209 933 . 045 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> APC Contractors, Inc. 4606 N.Bendel Avenue 93722 CAD 120804497 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> MAY 0 <br /> Forward, Inc. Landfill 7 2014 <br /> 9999 Austin Road <br /> Manteca CA 95336 <br /> Facility's Phone: 209 982 42$8 ENVIRONMENTAL= CAL000190080 <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, t.ItML1(TContainers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes <br /> 1- RQ, ASBESTOS, 9, N 2212, PGIII (ERG 171) 151 N/A <br /> Q _i BA Y <br /> w <br /> z 2. <br /> w <br /> 3 <br /> 4. <br /> 14.S dal HandlingInstructions nd Additional nform tion <br /> f�roject: 13.005 Edison li-t School <br /> Profile: 753310 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and Iabeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consign:nt conform to the terms of the attached EPAAdmowledgment of Consent. <br /> I certify that the waste minimization statement idenpfied in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generators/Offerors PrintedlTyped Name • Signature /� P /' Month Day 1Year <br /> lA r ,'"c f;' 4 L1 l/ .L!. 4 1 % Ulf <br /> f 'i <br /> T <br /> J 16.International Shipments <br /> � ❑Import to U.S ❑Export from U.S. Port ofentry/exit: <br /> K Transporter signature(for exports only): Date leaving U.S;:--_.__- <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> W Transporter 1 Printed/Typed Name Signature- Month Day Year <br /> O — / / / _ <br /> QTransporter 2 Printed(Typed Name Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity T Residue ❑Full <br /> ❑Type ❑ El Rejection Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> U <br /> Facilitys Phone: <br /> w 18c.Signature of Altemate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Code$(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. [1132 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Namea / Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are o solete. y DESIGNATED FACILITY TO GENERATOR <br />