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��aa f�ia—Enwronmental Protection Agency e ' !Form Apprb d OMB No 2050--M39(Eipire's 9 94), � See Instructions on back of a b. Tease print or type.- Foresignedll�awse o> 12pirchl hDepartment of Toxic Substances Controlirer. Sacramento,California UNIFORM HAZARDOUS^ 1. Generator's US EPA ID No. Manif�Document No. 2. Page 1 Information in the shaded areas " WASTE MANIFESTis not required by Federal law. of i 3: Generator' ame and Mailing Address A. State Manifest Document Number QB Ne'AL4 rDc&S t in .73.Ar W. ChgzT--r— y3 ,L cA.' 9s'z 0 G B. State Generator's ID 4. nerator's Picone O q G d 9 Q ! I� co C i 65. Transporter 1 Company Name" 6. US EPA ID Number C. State Transporter's ID/ r OP _ 1_D HDC SERVICES, INC. D 9 1 4 5 5 5 2 0 D. Transporters Phone (�31€))X69—i-s? 'f 7. Transporter 2 Company Name Q 8. US EPA ID Number E. State Transpo ter's ID U — F. Transporter's Phone - Q 9. Designated Facility Name and Site Address - 10. US,EPA ID Number G. State Facility's ID Z FORWARD INC, CAD (5 tj ? S 4 1 3 �7' 9999 SOUTH AUSTIN RD H. Facility's Phone �7 a MANTECA, CA 9533& 9 9 7 9 4 1 3 3 t29)952- ?cv 3 11. US_DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Contoiners . Total Unit 14. ry�Z No. T Quantity Wt/Vol I. Waste Number s•�2 a. States G R.Q. ASBESTOS, 91 NA2212, PG III 66LeC::?I i EPA/other o E f 0 N .. b. . _ .. . stare 0o E cN R EPA/Other o A t p T C. QQ." State Q ? 1',t AuU 1J9s EPA/Other w i d Z State ; w F U ��N`•••"`�I - - EPA/Other- i w � 1 --.--Z-- 3, Additional Descriptions for Materials Listed Above-- - - -- -- - -- -- ----- X. Handling Codes for-Wastes Listed Above CALIFORNIA REGULATED WASTE.ONLY LY a: l'43 b. f w � c• d. Q Z 15. Special Handling Instructions and Additional Information Q 24 HRS. EMERGENCY. 1-800-535-5053 < BDC SERVICES, INC. 766 SOUTH AYON AZUSA, CA 91702 Z Uj EPA REGION IX , ASBESTOS REMOVAL REQUIREMENT. 40 CFR 61 (BAGGED SEALED AND LABELED)Q�j , 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, -' 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 J if I am a large quantity generator, I certify that 1 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 l 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 „ waste management method that is available to me and that I can afford. Q Printed/Typed Nome i _ ` i turas &1. Month Day Year 8 , Z R R 17. Transporter 1 Acknowledgement of Receipt of Materials 0N Pri d/Typed Name igna re Month Day Year W P ' 0 18. Tran orter 2 Acknowled ement of Receipt of Materials J. CK w T Printed/Typed Name Signature • - Month Day Year tLE C) R w 19. Discrepancy Indication Space Q F U A Z '1 L I 20. Facility Owner or Operator Certification of receipt of hazardous moteploIscovered b this manifest except as noted in Item 19. T Printed/Typed Na a ig lure Month Day Year l. Y. L"_Z t -0 0 DON T WRITE BELOW THIS LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. DTSC 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.)