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Slifomra—Environmental Protedron Agenq � r orm Ap r ved-OMB Nof'050 0039Pves 930.94)" - See II15f�UC}IOOS OSI bQCIC Of a 6. Department of Toxic Substances Control 1 Please Or or type. F.I AAdesrgned for ase on elite(12pitch)., ler. - Sacramento,California 4 I 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas 1 UNIFORM HAZARDOUS 4 is not requked by Federal law. WASTE;,MANIFEST . CAc00Q1120i0 ,9 0 6 e 1 of i 3. or' e d Address A. State Manifest Document Number o .` C:` EJPZ:IS�° 3g SITE: SAME -� �^ .9 ,e �! 2325' W.' CHARTER WAY .2'I,� d ,J J 6Ln STOCKTON� CA, 95206 , B. State Generators ID j � 4. Generator's Phone (209) 467-0490 00 d S. Transporter 1 Company Name 6. US EPA ID Number G 5y G a y s 000 --- D. Transporter's Phone BDCSER.VICES, INC. CAD991455520 ;f , ? 1 —J+ 7. Transporter 2 Company Name, 8. US EPA ID Number E. State Transporter's ID V — F. Transporter's Phone 9. Designated Facility Name and Site Address 10. US EPA ID Number State Facility`s ID Z (X FORWARD INC. 1. ti ;�I Mo 9999 SOUTH AUSTIN RD H. Facility's Phone �U MANTECA, -CA 95336 CAD9907941 33 12. Containers 13. Total 14. Unit 11. US DOT Description(including Proper Shipping Name,Hazard Goss,and ID Number) Z No. I Type Quantity Wt/Vol I. Wcste Number .L a. Store.r .. ti3 u at. G R.Q. ASBESTOS, 9, NA2212� PG III ! EPA/Other C4 E10A 1 _ 00 N b. ! 11 St❑te. v E _ EPA/Other 0C'0 T C. AU �. !-1�,f _ ��. State O ---- R I=� EPA/Other W Z d• -� - State W U EPA/Other W ---Z -- "'Additional Descriptions for-tOcrteriais Listed Above- -- onarr (K. Handling Codes for Wastes Listed Above 0. a• Ch'y I b. Uj c. d, Q O15. Special BDC Handling Instructions and Additional Information. 24 HRS. EMERGENCY 1-800-5•5-5053 a SERVICES, INC. 766 SOUTH AVON AZUSA, CA -91702 Z. 1 W EPA. REGION IX Q.B. REBUILDERS ' -ASBESTOS REMOVAL REQUIREMENT. 41A.,CFR 61 (BAGGED, SEALED AND LABELED) i 16. GENERATOR'S CERTIFICATION: I hereby declare that thel contents of the consignment are fully and accurately described above by proper shipping name and are classified, J pocked,marked,and labeled,and are in all res m proper condition for transport b highway according to applicable federal,state and international laws. U p P�• P°Pe , sP° Y 9 aY n9 PP 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 I have determined to be i 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 n 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 N I � waste management method that is available to me and that I can afford. � 1 Q Printed/Typed Name Signaler_e_,�- Month Day Year ' Z T 17. Transporter 1 Acknowiedgement of Receipt of Materials W MoM R A Prin /Typ Name / -"'`— Sign re �' = -Day Year ce W P Zt 0 18. Trans orter 2 Acknowledgement of Receipt of Materials W T Printed/Typed Name Signature Month Day Year LL E t O R _ 1 LU 19. Discre oncy Indicatioh Space U A Z C I I Wome er or erator Certificati6ri of recei t of hazardous m rials cove ed b this manifest exce 'as noted in Ite 19. 1T j/ Sig re �� o Day, Year DO NOT WRITE BELOW THIS LINE. r Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. i DTSC 8022A (7/92) (Generators who submit hazardous waste for transport out-of-state, EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.)