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,ter . Protection Agency -�o'Ro`2050-0039(Expires 9-3094) See Instructions on back 0 ge 6. - Department of Toxic Substances Control r type. . Fcan designed for use on elite(12-pita. ,vriter. _ - - � � - Sacramento,California I UNIFORM HAZARDOUS 1. Generator's US EPA ID`N)o. Manifest Document No. 2. Page 1 Information in the shaded areas L y 3 Q3 is not required by Federal law. WASTE MANIFEST— .601Vj Ia 1 9 1 Qf 1 1 21 1 of 1 3. Generator's Name and Mailing Address r a 8 A. State Manifest Document Numbr LO 2325 W. Charter Way 9360 3 Q , y StOCklon� CA 95206 B. State Generator's ID LO LO 4. Generator's Phone 1�09i J 0 5. Transporter 1 Company Name 6. US EPA ID Number C. Stater spats IQ f t BDC SERVICES, INC. D. Transporter's Phone (1338)19-1.9_-1384 7. Transporter 2 Company Name 8. US-EPA ID Number E- State Transporter's ID Q - _ U F. Transporter's Phone N Z 9. Designated Facility Name and Site Address- '' --10:-USEPA ID Number I G. State Facility's ID FORWARD INC. A IL ? 0 k11 17 0 A 11 13 13 Q U 9999 SOUTH AUSTIN RD H. Facility's Phone . © a MANTECA, CA 95336 7 1 (203}98 4298 U 12. Containers 13 Total 14. Unit 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) /y� Z - No. Type Quantity Wt/Vol 1. Waste Number a. 07 G R.Q. ASBESTOS, 9, NA2212, PG III 1 I EPA/Other c:i E 1P1 20 10 1a l 00 N b. State C9 E . NR .. - . - - - - EPA/Other v A nn m:i O T C. State a? O R EPA/Other w d. I State Z LU U U lJ`i l� EPA/Other w Additional.0e5crip}ion5_�9r"Materials-Listed-4bgvt____,. „ __ K--Handling Codes for Wastes Listed Above CALIFORNIP REGULATED WASTE ONLY a. b. LU C. d. Q 7- 0 O 15. Special Handling Instructions and Additional !nfou—tion _ _ - 4 HRS. L;�E_RGEc'4;CY 1-800-��t-5053' a BDC SERVICES, .INC: 766, SOUTH WON AZUSA, CA 91702 w EPA REGION IX ASBESTOS REMOVAL REQUIREMENT 40 CER 51 (BAGGED SEALED AND LABELED) �. 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, Q 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 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 J 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 N 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 mono gement method that is available to me and that I can afford. Printed/Typed Name Signature Month. •._._ Day -. Year O / sr (! g d o� S 1 Z a 17a8. Tra§nsporter Trans orter 1 Acknowledgement of Receipt of Materials v Uj 5. a - 1.—� Signafvr - �� _ _ Month Da Year- O N U.1 v �/' G - 13 o Acknowledgement of Rec t of Materials L T Printed/Typed Name Signature Month Day- Year" U_ E O R 4.. w j 19. Discrepancy Indication Space N Q IF U A Z L 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except asnote Item 19. T Pri /ed/T y ed Name Si na �_ Month Day Year Y I ,1 C w DO NOT W ITE 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.)