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/Protection Agency —,0-0039(Expires 9.30-94) See Instructions on back of Page 6. 'Deportment of Toxic Substances Control •,rm desig`_ed for use on elite(12-pitch)o---writer. 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 low. WASTE MANIFESTC Q D / 1�? 4 O g 0 9 1 1 ' 1 of 1 3. &nefatpT' b�e� Mailing Address A. State Manifest Document Number L ' 09 in ' B. State Generator's ID11� CN swd te) 4. Generator's Phone (? g 6, 01.P f_ 'N00i C) 5. Transporters Company Name 6, US EPA ID Number C. Sta e T aqs o eh I O BDC SERVICES, INC. 1 op D. Transporter'sPhone (813)959 136`f 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID a 1, U - F. Transporter's Phone Q 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID c--1 W FORWARD INC. L1 3 9999 SOUTH AUSTIN RD H. Facility's Phone T U- zi MANTECA, CA 95335F.P P P P. 7 1 3 { 0` )9Hti-4 98 Q U 12. Containers 13.,Total 14. Unit LO O Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. T Quantity Wt/Vol 1. Weoste Number Slot 51 3 G R.Q. ASBESTOS, 9, NA2212, RG III 0101/ if EPA/Other N E State 0 b. 0 0 N 00E (1 V6 }' EPA/Other N R i A L State 6 T c. A b O MAY 3 0 1995 R EPA/ her J/ W d• a. State sssss Musaltvzo, W - ..►M.� U EPA/Other W V) K, Handling Codas-for.Wastes Listed Above-. Z 1 Additional.Descriptions.for Materials Listed.Above,.... CALIFORNIA REGLILAT ED WASTE ONLY 03 b. W .. +- d- Q Z 15. 5 Special Handling Instructions and Additional Information + O p g 24 HRS. EMERGENCY 1-800-5--"5`0513 ,. a HDC SERVICES, INC. 766 SOUTH AYON AZUSA, CA ,91702 Z W ERA REG 1 ON IX M ASBESTOS REMOVAL REQUIREMENT 40 CFR 61' (BAGGED SEALED AND LABELED) jQ,8ur 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, Qpacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. U , J 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 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 CL threat to human health and the environment;OR,if I am a small quEintity generator,I have made a good faith effort to minimize my waste generafion and select the best to waste management method that is available to and that 1 can afford. O Printed/Typed Name ` Signature Month Day" Year :w4t,�, -- P 12 17 1�-� U T 17. Trans orter 1 Acknowled ement of Recei t of Materials v - Z tt Month Day Year L LU A Pr'nted/T ped No j I--- Signator f w P r e- ( /1 D 2 0 18. Trans orter 2 Acknowledgement of Receipt of Materials WR Printed/Typed Name - Signature - Month Day - Year, 1 O R { W 19. Discrepancy Indication Space F a , U A Z j 1 20. Facility Owner or Operator Certification of recei t of hazardous matEnols covered b this manifest except as noted in Item 19. l TM.; Day Year' t T Printe /Typed Name Sig re y �� rX his DO NIOT WRITE BELOW THIS LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. 22A (9/93) (Generators who submit hazardous waste for transport out-of-state, DTSC 80 EPA 67022A ( , produce completed copy of this copy and send to DTSC within 30 days.)