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State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-94) See Instructions on back of ? 6. Department of Toxic Substances Control' ' <br /> Please print at type. -Form designed/or use on elite(12pitch) ler., . , Sacramento,California <br /> tos' <br /> UNIFORM HAZARDOUS ' 1.'GenereUS EPA ID No. Manifest Document No. 2. Page I Information in the shaded areas 1 <br /> WASTE MANIFEST tt'��C A C 0 0 0 1 2 0 1 if 9 I 2 of 1 <br /> 4 0 1 3 1 is not required by Federal law. <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number q <br /> 0 Q.R. REBUILDER SITE: SAME 9264� L � '4 <br /> 2325 WEST CHARTER WAY L <br /> B. State Generator's ID <br /> STOC'KTON, CA 95206 _ <br /> � 4. Generator's Phone (209) 467 0490 1 1 Y .3 01 2 r' 11' <br /> 00 <br /> d 5. Transporter 1 Company Nome b. US EPA ID Number C. State Transporter's ID (� �`�-�� <br /> 0 U J <br /> 00 <br /> BDC SERVICES, INC. D 9 11 11 a 6 ✓ 5 2 1f-' D. Transporter's Phone 2C­,0)44`8 523 <br /> j <br /> Q7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporters ID <br /> U <br /> F. Transporter's Phone <br /> NJ Ea 11�J1.ifltx. `IJ Nome and Site Address 10. US EPA ID Number G. Stcte�,Fa ilitgIi IOj O 0 y } 1 <br /> Ir:Y4Ht Cll <br /> Y) 0 9999 SOUTH AUSTIN ROAD f 1 I ( I I !� I� I <br /> LL. H. Facility's Phone � <br /> -�a MA,JT'E7CA CA, 95336 D 9 9 0 7 9 4 1 3 3 269)982 4297 <br /> n I <br /> U 12. Containers 13. Total 14. Unit <br /> Sl'Z I1. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number) No. Type Quantity Wt/Vol I. Waste Number <br /> "R°,Q.° HAZ ZOUS SUBSTANCE SOLID N.O.S. ss+atel <br /> G ORM E NA 9188 (ASBESTOS) ^r ` f EPA/Other <br /> c,4 E ,f�` <br /> N b, State 1 <br /> a? i r <br /> vE rr, <br /> R D EPA/Other <br /> T M Y 1993 State <br /> EPA/Other <br /> � R i <br /> Fd w.... ...... ........... State <br /> w <br /> U EPA/Other <br /> LU <br /> N <br /> ___,Z. J.4 dit%onal Descriptions for,Materiols.Listed Above_ a. b1 <br /> K,.Nandling Codes-fox._'Nastet <br /> V) t::-� . I�'ORNIf? R ULc�T 013 <br /> . <br /> LU <br /> irL v <br /> C. d. <br /> Q CTLL IN TTUiC: S0 ) =,35 5G=>? F'( R E-t_ GEs X"y <br /> O 15. Special Handling Instructions and Additional Information <br /> a BDC SERVICES, INC ASBESTOS REMOVAL REQUIR&MEN2 40 CFR 61 <br /> Z 766 SOUIPH AYON AVE. (BAGGED, SEALED AND LABELED) <br /> _ AZUSA, CA 91702 Q.B. REBUILDER. <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> J <br /> packed,marked,and labeled,and are in all res m proper condition for transport b highway according to applicable federal,state and international laws. r <br /> Q P P�� P Pe P Y 9 Y 9 PP <br /> U <br /> If I am a large quantity generator, I certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> —' 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 /> CL threat to human 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 /> to <br /> waste management method that is available to me and that I can afford. <br /> QPrinted d Nome Signature Month Day Year <br /> - <br /> U <br /> T 17. Tr-insporter 1 Acknowledgement of Receipt of Materials <br /> LLJ A Prin /Typed N,[q[,me / n re Month Day �Ye r <br /> _of S V. (J\ v� t u O <br /> W r <br /> 0 18. Trans o er 2 Acknowled ement of Receipt of Materials <br /> w T Printed/Typed Name Signature Month Day Year <br /> LL E J <br /> p R <br /> LU 19. Discrepancy Indication Space <br /> in <br /> Q F - <br /> U A <br /> Z C <br /> 1 20. FacilityOwner or Operator Certification of receipt of hazardous materials covered by lhts manifest exfce6t as noted in Item 19. <br /> T Printed/Typed No Signature Month Doy Year <br /> Y 0 2 S s �" <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A (7/92) - (Generators who submit hazardous waste for transport out-of-state, <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />