Laserfiche WebLink
AI-3 i. <br /> Y� <br /> �. S16fk ot-G-�fo�nia= n114??n11e49l Protection Agency' - - - <br /> See Instructions on back of 'e 6. Deportment of Toxic Substances Control <br /> `n m �,,,-ed OMB No.2050-0039(Expires 9.30-94) _ <br /> Please print or type. rm esigned for use on elite(12-pitch).,,- writer. - <br /> Sacramento,California <br /> , <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> NIFORM HAZARDOUS is not required by Federal law. <br /> WASTE MANIFEST D Q UII 2D IT yj 9 1 of 1 = <br /> 3. Generator's Nam an Maili ddress A. State Manifest Document Number <br /> r� r`�� s s�Te sic.. ` <br /> Z SW r C�1d+Q TPJL WA y 8. State Generator's ID <br /> 11� ! S 7yo�K rcar�! C r0- q.�"'�.4� <br /> J.1 91 <br /> CN 4. Generator's Phone 6 9 V � <br /> 6. US EPA ID Number C. State Transporter's ID — <br /> p 5. Transporter 1 Company Name �j <br /> O <br /> 09D. Trarisporter's Phone <br /> BL1C SERVICES, INC. D 9 1 4 5 5 <br /> 7. Transporter,2 Company Name v8. US EPA ID Number E. State Transportar's ID <br /> Q <br /> U F. Transporter's Phone <br /> -' G: State Facility's ID - - '-- <br /> V/Q 9. Designated Facility Name and Site Address .. :_ _....:._. 10.-US EPAIDNumber----- <br /> Z . C !AD79130 1 94 i - 3 <br /> FORWARD INC. <br /> CD 0 9999 SOUTH AUSTIN RD tj 9 l�1 7 9 4 i 3 H. Facility's Phone 1 <br /> C}� MANTECA, CA 35336 <br /> Cn U 12. Containers 13. Total 14. Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. T e Quantity Vltj Vol I. Waste Number <br /> pyo Z - - Staiei 0.1 <br /> a. <br /> R.Q. ASBESTOS, 9- " NA2212, 'PG III C D d U EPA/Other <br /> a G <br /> s C14 E - �EPA/Other <br /> ate <br /> r co N b. <br /> 0-o E <br /> s N R <br /> 'Q A State - <br /> _ T u 5 1995 <br /> I C? MAR 1 EPA/ her <br /> R <br /> cd <br /> State <br /> ?r Z d EPA/Other <br /> f U <br /> k tL K. Hcndl <br /> ir.g Codes for Wastes Listed Above <br /> ----- <br /> -Z - - J:-Additional Descriptions for Materials Usted.Above- :._, __. -. ..- --_ _ - _ - - <br /> a- <br /> CAL'I�'OPNIA REGULATED WASTE ONLY <br /> uj <br /> O15. Special Handling Instructions and Additional Information L�` HR -iriE RGENC 1 1-88JKJ"rJv'�J—SrUJ.:� -' <br /> ^; RDC SERVICES, INC. 766 SOUTHAYCr1 r+ U'� I.A 917 2 <br /> < <br /> a <br /> Z EPA REGION IX - <br /> uj ASBESTOS. REMOVAL .REQUIREMENT 40 GFR 61 (BAGGED SEALED AND LABELED) Q.t�, <br /> J <br /> 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 /> Qpacked,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 /> If 1 am a large quantity generator,i certify that I have a program in place to reduce the volume and toxicity of write generated to the degree I have determined tou re <br /> economically procticable,and that I have selected the practicable method of treatment,storage,or disposal currently <br /> 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 ffort to minimize my waste generation and select the best <br /> V) waste management method that is available to me and that I can rd. <br /> � f���9R - i -Month � Day Year <br /> OrA <br /> yped Name n e Q 3 9 <br /> Us orter 1 Acknowle ement of Recei t a aterials - <br /> Month Day Year <br /> Ztyped Name It St9law <br /> LLj <br /> s orter 2 Acknowled ement of Receipt of Materials <br /> Luyped Name <br /> Sig Month Day Year <br /> tL <br /> O <br /> Wrepancy Indication Space <br /> V) <br /> U <br /> C <br /> Z I <br /> L <br /> I F ill Owner or O erator Certificaf n hf receipt of hazardous erial ve this ifest ex not t Item 19. nth Day Year <br /> T ri ped Name gno <br /> Y _ <br /> D NOT WRITE BELOW THIS LINE. <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 /> produce completed copy of this copy and send to DTSC within 30 days.) <br /> EPA 8700-22 <br />