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r <br /> .—naTProtection Agency: <br /> ___--No.2050 0039(Expires 9-3044) ' See Instructions on back of je 6. /V Department of Toxic Substances Control <br /> _a"pe. Form designed for use on elite(12pitc6, iter. Sottomento,California <br /> 1. venerator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS <br /> is not required by Federal law. <br /> WASTE MANIFEST vy 10 000/948 8 3 91 4 1 of 1 <br /> 3. Generator's Name and M fling Addre'ss A.-State Manifest Document Numb_r <br /> QR��bv� 1�eo s <br /> LO cJZ �A 9P` <br /> t\ GB. Stat(eI%Genelraftor's ID <br /> N TO ` rytQ <br /> LO 4. GerSator's Phone � <br /> ,F(i, <br /> r i7 / <br /> / 3 <br /> p 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID ;,+� <br /> OP <br /> BDC SERVICES, INC. 1CiAjDi9i8i1i4j5j5j5j2j OI D. Transporter's Phone €311-1_-`)159 131".3-'I <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID <br /> U <br /> T V <br /> �/♦ F. Transporter's Phone <br /> Z 9. Designated Facility Name and Site Address - 10. US EPA ID Number G.'State Facility's ID <br /> 00 W FORWARD INC. G' AlD1 91 019 t 3 <br /> 00 LL 9999 SOUTH AUSTIN RD H. Facility's Phone <br /> MANTECA, CA 95336 C A D 9 9 0 7 9 4 1 3 3 (209)982 -4 F <br /> U 12. Containers 13. Total 14. Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> Z No. Ty Quantify Wt/Vol I. Waste Number <br /> H a State 1 1.L <br /> 3 RQ ASBESTOS, 9, NA2212, PG III <br /> Ca U/ / ? f �/ EPA/Other <br /> o E (� (/ / <br /> 0o -N b• State <br /> 00 E <br /> v • <br /> v Ar-+r-rae-tu++r EPA/Other <br /> V <br /> 00 T MAR 1994 State <br /> O <br /> W R EPA/Other <br /> w <br /> Zd. State <br /> LU <br /> U <br /> SPA'/Other <br /> LU <br /> OJ. Additional f3escriptions for,Materials Listed Aboye_ _ � s e, a listed Abo+e <br /> a- FOIR CHEMICAL' EMERGENCE' CALIFORNIA REGULATED 03 e. <br /> W {AS ClvLYGFf <br /> 0TRAC: 1.80 -535. 51C .LL IPF <br /> C. d. <br /> Q 29 HRS. PER, i3AY, f}AYS PEt7 <br /> 0 15. Special Handling Instructions and Additional Information <br /> a BDC S VICES, INC. 766 SO. AYON AZUSA, CA 91702 , <br /> Z <br /> w ASBESTOS REMOVAL REQUIREMENT 40 CFR 61 (BAGGED, SEALED AND LABELED) <br /> t— <br /> __j 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 /> pocked,marked,and labeled,and are in all res m proper condition for transport b highway according to applicable federal,state and international laws. <br /> U P P�• P P sP Y 9 Y 9 PP <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 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 /> Nthreat 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 /> waste management method that is available to me and that I can afford. <br /> 0 Printed/Typed Name ignature Month Day Year <br /> U T 17. Trans o er 1 Acknowledgement of Receipt of Materials Ix <br /> LU q Printed/Tye Name Signafurp Month Day or <br /> WS <br /> tet✓/4 <br /> 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> w T Printed/Typed Name Signature Month Day Year <br /> LL. E <br /> 0 R <br /> LU 1-9. Discrepancy <br /> \(Indication Space <br /> ZC <br /> _ 1 <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials•.covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name g �reMO;1 <br /> Day Year <br /> Y \\ <br /> ICIHDO NOT WRITE BELOW THIS LINE.�� <br /> i' 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 />