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nr ronmental Protection Agency MB:No.205MM39 Ex v 9-30-94 $@@ Instructions on back of page 6. �� F 1 P K ) p2 9 Department of Toxic Substances Control ,nf or type. Form designed for use on elite(12-pitch) �riter Sacramento,California UNIFORM HAZARDOUS nerator's US EPA ID No., Manifest Document 2. Page 1 Information in the shaded areas is not required by Federal law. WASTE MANIFEST Aloll, 1 0 1 0 9 9 4 6 12 1 of 1 3.ic.rUrotorh ftr nbvlq ng Address. .SIr��+��B.ANE A. State Manifest Document Num .. 0 2325`W:..CHARTER.WAY 3 0�4 STOCKTON, `CA 95206 B. state Generator's ID 4. Generator's Phone ®9 467-0490 p 7 9 1 J in 00 1 5. Tronsporter,l Company Name 6. US EPA ID Number C. State Transporter's I 00 BLT SERVICES, INC. - 1 - D. Transporter's Phone: .1 ._x+69 I.1 f.`f 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter`,ID l : V ^tt F. Transporter', Phone `V Q 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID - OO FORWARD, INC. I-%.� Q � 4t' O 9999. SOUTH AUSTIN RU. H. Facility's Phone cr) MANTECA, CA 95336 9 7 9 1 aO9-982-4293 Q C). U - - - 12. Containers 13. Total 14. Unit Z - rr� 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) . No. T Quantity Wt/Vol 1. Waste Number W M = _ Slat 11 I (� 3. RO ASBESTOS, 91 NA2212, PG III / EPA/other cv E ell ( l? ON b c r - State NQ EPA/Other v A OT C. State OP O .- .R EPA/Other t d. - State Z V EPA/Other w N - -- ___._Z•___ J_Additional Descriptions for Mtatenals Listed Above----f_i--- -- - K-Ffandling Codes for-Wastes-Listed-Above a. ` .b. - a N w d' c. d. Q .. O 15. Special Handling Instructions and Additional Information - r��^ E i l'��i^iI=Nr-' iD-0 e-`5--��1(''' - G�f HRJ. Cf{�,. _1 1 1 -JJ'J J_.� a BDC -SERVICES, INC. 766 SOUTH AYON AZUSA,, CA 917,�_ _ Z FPI-',.F<EGION "IX _ P.SBE S IW REKNAL REQUIREVILLW.X10 CFR 61 (BAG(qE.D,, SEALED i�.D' I-AB LED). .. - Q.B. REBUILDER 16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, -� packed,marked,and labeled,and are in all respects in proper condition for transport by.highway according to applicable international and national government regulations. V If 1 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 -+ 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 d 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 waste management method that is available to me and that 1 can afford. Printed/Typed N e $i nature Month Day Year V T 17. Transporter 1 c owled ement of Recei t Materials Z R ��wrr�� A Printed/Typed me SignaturejLfliff Mon oy - ear V N WS LU P 18. Trans orter 2 Acknowled ement o Recei t of Materials w T Printed/Typed Name Signature Month Day. Year U_ E p R tL 19. Discrepancy Indication Space f Q F V A C Z I F L 1 20. Facility Owner or Operator Certification of receipt of hazardous ma rials covered by this manifest except as noted in Item 19. T Pri ted/Typed Name Signature Month ,^J Day Year Y Vvw DO NOT WRITE BELOW THIS LINE.. i' t Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. TSC 8022A (9/93) (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.)