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,-rjWrIan Agency O O ✓V <br /> 39Ex fres 9-30-94 <br /> ( P ) i See Instructions OA bdC1C Of hpg@ 6. De artment of Toxic Substances Contra <br /> desi ned for use on stile(12-pitch)typewriter. - P <br /> Sacramento,California <br /> `!UNIFORM HAZARDOUS Generator's US EPA ID No. Manifest Daum, <br /> r 2. Page 1 Information in the shaded,oreas-es Con' <br /> WASTE <br /> p�MANIFEST I � � g (� � 4 .7 e i of � is not required by.Federal law. 'a <br /> 3 �.D.�oICUtLITtT( g Address as,. I <br /> SITE: SAME A. State Manifest Document Numb r ± J <br /> 2325. W. CHARTER WAY <br /> TOCF4TON, CA 952�b6' a <br /> x' 49 X467—@494 t e Generator's ID <br /> 4. Generator's P3600478 <br /> hone '�, i ^• I <br /> 00 j <br /> O S. Transporter 1 Company Name �6. �EPNumon <br /> Ate Transporter's ID <br /> BDC�SERVICES7 INC. . 1 Tronsporter's Phone ,_r��r-r�'_ :3._7. Transpoer Company Name 8. US EPA JII14ra�hec--�- _ <br /> Q ------ „5jRte Transporter's ID <br /> U _ <br /> F. Transporler's Phone <br /> Q 9. Designated Facility Name and Site Address 10. US EPA ID Number'' G. State Facility's ID <br /> N Ce FORWARD, INC. : C 1 .;1 t: 7 `: i s <br /> cf- U- 9999 SOUTH AUSTIN RD. I ` - <br /> MANTECA, CA 95336 7 .9 H Facility's Phone <br /> C) U a09-982 Q98 <br /> ILD Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> M = a. No. Type Quantity Wt/Vol I. Waste Number <br /> ~ $tot 1 Ll 1 <br /> C37 3 G RG ASBESTOS; 9, NA22I2, PG <br /> N b. I G EPA/Other <br /> 0o <br /> E State <br /> CN R <br /> A EPA/Other <br /> o T C. <br /> 0o O _ <br /> state <br /> R <br /> LU EPA/Other. <br /> Z d. <br /> 1 <br /> W State - - <br /> w <br /> EPA/Other <br /> Z J Additional Descriptions for Materials Listed Above K. dandling Codes for Wastes listed Above <br /> N ISEK l' Jel_ ) r L'L f i. 1�' a- 03 b. <br /> W . . - <br /> J c_ <br /> Q d: <br /> Z <br /> O 15. Special Handling Instructions and Additional Information24`-HRS. EMERGENCY 1 800-5 sS ,;nr <br /> a BDC.: SEItttICES,:;INC. ''76& QUTH, AVON .AZUSA CA 91702 , ; <br /> Z A REGIOL�- Ih <br /> = <br /> ASBESTOS: RF610VAL TtEX!ISR 0 CSR 61 RAGGED,`SEALED hivD 1,ABErED) -I3, 12 3UILDE�l:J. <br /> J 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, <br /> Q packed,marked,,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> U _ <br /> .-.i 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 l have deTetmined to be <br /> economically practicable and that 1 have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> n ,threat to human.health and the environment;ORif I am a small quantity generator, I have made a <br /> N f ty 9 good faith lf rt t <br /> waste management method that is available To me and that I can afeo minimize my waste generation and select the best <br /> ford.. <br /> 0 Printed/Typed Name - <br /> Signature Month Day Year <br /> >- / /IL/ v /, 7 <br /> U runs orter 1 Acknowled ement of Receipt of Materials <br /> Z T <br /> W R <br /> U 'N A*n /Typed�;Name <br /> ^ (� Mont Day Year <br /> a' s \ r]W P (010 /``o 2 Acknowled ement of Recei t of Materials <br /> W i Printed/Typed Name <br /> W Ere Month Day Year <br /> O R <br /> N19. Discrepancy Indication Space <br /> Q F <br /> U A <br /> Z C <br /> 1 <br /> L <br /> 1 20. Facili Owner or Operator Certification f recei t of hazardous materials covered b this ma 'fest except as noted in It e 19. <br /> T i Typed Name M h <br /> Y � �� t f •✓� < 8 a <br /> O NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DISC 8022A (9/93) <br /> EPA 8700-22 (Generators who submit hazardous waste for transport out-of-state, <br /> produce completed copy of this copy and send to DTSC within 30 days.) <br /> /T , <br />