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�rmental Protection Agency See Instructions Oh bdCK OT ��� v. ! v- J&1-.,,._,..- -_- _ <br /> 2050-0039(Expires 9- 9 ), _ Sacramento,California <br /> /orm designed fonvse bri2pitdr)fypewrirer. - <br /> Manifest Document No- 2. Page 1 ]Number <br /> ation in the shaded areas <br /> L <br /> torsUS EPA ID No. equired by Federal law. <br /> UNIFORM HAZARDOUS WASTE MANIFEST AC 0 0 0 1 2 0 1 0 8 9� 3 lot 1 <br /> A. State Manifest Document <br /> /3. Gpeenegr tor's�{NagmeuanLLd❑❑MEaaill'Rin Address LOCATION SAME v'f <br /> 225 WS7ICHAREk WAY <br /> STOCKTON, CA 95206 <br /> B. state Generator's ID <br /> 4. Generator's Phone ( <br /> 20 -467-1026 H Y H� Q 3 5 0 2 7 �3 I ; <br /> 40 C. State Transport er's ID <br /> 00 6. US EPA ID Number JL' <br /> O 5. Transporter 1 Company Name <br /> O D. Transporter's Phone <br /> 00 CAD981A55520' <br /> BDC SERVICES. INC. E. State transporters ID <br /> 7. Transporter 2 Company Nome 8. US EPA ID Number <br /> UF. Transporter's Phone . <br /> ____ .G. State Focility's.ID <br /> a 9. Designated FacilityN __ome'and Site Address - "10:US EPA-ID Number" <br /> nW- , FORWARD, INC. HCAD 9 9101 7 9 4 I1 31 31 <br /> H. Facility's Phone <br /> 9999 SOUTH AUSTIN ROAD CAD 9 9 0 7 9 4 1 3 3 209-982-4298 <br /> 1) MANTECA. , CA 95336 <br /> U - - 12. Contbiners 13. Total 14. Unit <br /> Z 11. US DOT Description(including Proper Shipping Nome,Hazard Class and ID Number) <br /> No. T e Quantity Wt/vol I. Waste Number <br /> / State 151 <br /> �tsus, <br /> H a EPA/Other <br /> G State <br /> 6i00 <br /> co E EPA/Other <br /> CN A, OCT Z State <br /> T c•00 EPA/Other <br /> _ O <br /> ce R State <br /> W <br /> t— <br /> Z d• EPA/Other <br /> U <br /> U I -X:-Handling-Codes for-Wastes Listed AboveLo <br /> -- --- <br /> _0 -_ J.-Additional Descriptions for Materials t�stedAbove,i-- .- - a• 03 i b <br /> a FOR CHEMICAL EMERGENCY CALIFORNIA REGULATED <br /> LIJ <br /> "' DURING TRANSPORTATION ONLY WASTE ONLY <br /> a CALL. T�dFOTRAC: 1-B{30-535-5053 d. <br /> Q 24 HRS. PER DAY, 7 DAYS PER WEEK <br /> OIS Special Handling Instructions and Additional Information <br /> Z BDC SERVICES. INC. 766 SOUTH AVON AZUSA. CA 91702 <br /> ASBESTOS REMOVAL REQUIREMENT 40 CFR 61 (BAGGED SEALED AND LABELED) <br /> r .B..REBUTLDERS described above <br /> J 16. GENERATOR markand c <br /> ed, lab ed,and ahere in alfdeclare th nt the contentsroper and tion for transport r highway according iccurately <br /> federal,state shipping name <br /> international national law d are classified, <br /> Q <br /> packed, <br /> P�h .P <br /> U <br /> 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 1 have determined to re <br /> 1. economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> a threat to Kumon health and the environment;OR,if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> i N Month Day Year <br /> waste mono ement method that is available to me and that I can afford. <br /> 1 rgno - <br /> 0 Printed/T d Nome � <br /> ` e,, G�r z <br /> - - <br /> Z 17. Tr s orter 1 Acknowled ement of Recei t of Materials Month Day or <br /> R Si ature <br /> UN,Printe / y ed a / <br /> r: <br /> o' of Recei of Maerials Month Day Year <br /> 18- Trans orter 2 Acknowlement <br /> Signature <br /> W T <br /> E Printed/Typed Name _ - <br /> lJ.. / - <br /> O R <br /> sU 19. Discrepancy Indication Space <br /> a F /* W FSS G � Gil f rt <br /> U A <br /> Z C <br /> I <br /> L Month Day Year <br /> f 20. Facili Owner or Operator Certification of recei t of hazardous materials covered is manif exce t as note in-Item 1 / // <br /> Signa �e <br /> T Printed i ed in <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> (Generators who submit hazardous waste for transport out-of-state, <br /> DTSC 8022A (7/92) produce completed copy of this copy and send to DTSC within 30 days.) <br /> EPA 8700-22 <br /> ���_• — `—Ye ,:;w GENERATOR RETAINS <br />