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/.�` <br /> �ctififom' ro—EnvironmentaLProtectiori Agency <br /> corm A roved Oh18 No'� Q50--0039 Ex-vis 9-30.94 - - See I115t�UCtiOnS Ott bUCIC Of 1@ 6. <br /> .% Pp t. c f_P ) `�', Deportment of Toxic Substances Control <br /> Please print or'f'� '.-' Form dthigned`for use on elite(12pBch, iter. - - - Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST_ 1 2 1 9 0 9 4 1 a of I <br /> - 3•6egG:ator0,tgiefgnMaif9g Address - SI`iE SAME - A. State Manifest Document Numr <br /> `0 9 <br /> LO 2325 W. CHARTER WAY <br /> I. STOCKTON,. CA: 95206 B. State Generator's ID <br /> LO 4. Generator'sPhone ?091467-0490 ) Y �1 (r `3 1 'a <br /> OP <br /> 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's tD�t <br /> BDC SERVICES,. e 1 D. Tronsporters Phone 7 INC. i f_ ' 3111 13 6` <br /> 7. Transporter 2 Company Nome 8. US EPA ID Number-' E. State Tronsporter's ID <br /> a <br /> U <br /> F_ Transporier's Phone <br /> Q - 9. Designated Facility Name and Site Address 10, US EPA ID Number G. t te, aciI ' ID <br /> )0 oFORWARD INC, I f{' <br /> LL 9999 S0bTH AUSTIN RD. H. FacEity'5 Phone <br /> MANTECA, CA 95336 <br /> a <br /> U I -' 12. Containers 13. Total : 14. Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> ,Q Z - � —No: Type Quantify Wt/Vol I. Waste Number <br /> S a. - - .. _ .. _ - - - State j. . <br /> 3 RQ ASBESTOS, 91 NA2212, PG III <br /> E EPA other <br /> N � � � oo�o Y / . <br /> O00 N b• State <br /> co E i <br /> NR - - EPA/Other <br /> AM 1 <br /> 0 Z_ T <br /> T C. <br /> State <br /> 00 'O <br /> R OCT 25 . , <br /> i EPA/Other <br /> LU <br /> d. <br /> . .. l z.J,ti ?L ` — State <br /> LU <br /> � - <br /> U J!lJJJ� <br /> -------- EPA/Other <br /> I I EPA/Other <br /> LU <br /> Z _- J. Additional Descriptions for-Materials Listed Above— - --- -__..___ __..__. K Handling Codes for Wastes Listed Above <br /> r-— <br /> r�I,Ir� k�)It f� n11,f�'s' 1) ri ':`L' . Ub. <br /> L�i;i Ltd <br /> LU <br /> C. d. <br /> a 15 Special Handling Instructions and Additional Information. <br /> 24 HRS: EMERGENCY I 00-535--553 <br /> Q BDC .SERVICES, INC. 766'.SOUTH AYON .AZUSA, CA 91,702 <br /> Z EPA kOGION_:IX <br /> LU ASBE5DOG ,REMOVAL'.REQUIRRUM 40 C'ER 61 (Eacp ed, Sealedand Labeled) Q.B. Ra; UILDI <br /> 16. GENERATOR'S CERTIFICATION- 1 hereby declare that the contents of this consignment are fully and accurately descrbed above by proper shipping name and are classified, <br /> —' 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 /> J If I am'o large quantity generator, 1 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 1 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 /> waste management method that is available to me and that I can afford: <br /> 0 Printed/Typed Name - $ignehrra.--�' - ---- .. .. Month Day Year <br /> 10 <br /> O � <br /> U T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> Z A Printe /Typed.Name Si�td Month Day Year <br /> LU P <br /> 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> LU T Printed/Typed Nome Signature Month Day Year <br /> LL E <br /> 0 R> <br /> LU 19. Discrepancy Indication Space <br /> t� <br /> a F <br /> ^ <br /> U A <br /> Z <br /> 1 2 Fa i ity Owner or Operator Ce 'on of receipt of hazardous materiatfZbverofty this manifest a noted in Item 19. <br /> T ri /Typed me ignatu Month Da Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> _ i <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A (9/93) (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 /> i <br />