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State of Cabfornia—Environmental Protection Agency Y lct� <br />Formpppproved aMB No. 2050-0039 (Expires 9-30-99) <br />Please print or type. Form designed for use on elite (12-pitchij 'Pr <br />O <br />LO <br />t� <br />N <br />LO <br />O <br />0 <br />oD <br />Q <br />V <br />Lf)0 <br />�a <br />MV <br />T -4Z <br />OW: <br />m <br />0 <br />v <br />(V <br />v <br />0 <br />O <br />00 <br />cwf <br />LU <br />Z <br />LUV <br />LU <br />Z <br />0 <br />V) <br />w <br />Q1: <br />Q <br />Z <br />0 <br />Q <br />Z <br />LO <br />0 <br />LU <br />N <br />Q <br />V <br />Z <br />See Instructions on back of -nae 6 <br />Department of Toxic Substances Control <br />DO NOT WRITE BELOW THIS LINE. o � <br />DTSC 8022A (4/97) <br />EPA 8700-22 1 Yellow: GENERATOR RETAINS <br />Jacramento, California <br />UNIFORM HAZARDOUS <br />- ieratar's <br />US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />WASTE MANIFEST <br />snot required by Federal law. <br />I {- I <br />I f.' f.� T /} t '� t ''J �y C J <br />Of t <br />3 Generator's Name and Mailing Address <br />l�E REHLiILflERS <br />>. <br />"A State Manifest Document Number 9$-51.�� <br />2-325 t•IFST CHARIER [IA1 <br />SI iE: SIAr1E' <br />5 2 --.- <br />,State <br />rocr i bi i+ F I; 9�i��I�1F. <br />B Generator;y 1D.. <br />4. Generator's Phone ( iC '-�) L{(_} j._[y=} �4r <br />r. -3 5 .0 2 4 .9 1 I r) <br />5. Transporter 1 Company Name6. <br />US EPA ID Number <br />C. State Transporter's ID <br />KIC SPECIAL <br />D..Transporter'sPhone <br />f� F-! I'i L.� 0 i i t•' c. .i. <br />i>F•',f }96.`�-1 8�+ <br />�� ,. <br />7. Transporter 2 Company Name <br />8. US EPA ID Number <br />E. StdteTransporter.'s.IR . <br />F. Transporter's Phone - <br />9. Designated Facility Name and Site Address (-r�_ f (J US EPA ID Number t� <br />GStat cj�{[y' ID (� (J �} 1� ('+t ,r•�� `y - <br />F(JR6)ARD INC. — A;7,PROVAL- �t-%t7`_i,-!o <br />'71 99.3 SOU 1 H AU'ST I N [--1)0"',,,. <br />H. Facility's Phone - <br />l/ (J C.!' 1 i.% <br />t,AITECA, CA 95,336 <br />11 . US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />14. Unit <br />No. <br />Type <br />Quantity <br />Wt/Vol <br />I. Waste Number <br />a. <br />State . . <br />15r <br />R. Q. ASBESTOS, 94. 144e_ 1 �+ <br />PGI I I t.I'eFfE �' �r` j i } <br />EPA- <br />G <br />10 <br />P1 I <br />CM�t?Of <br />E <br />N <br />b. <br />State . <br />E <br />EPA/Other <br />R <br />A <br />T <br />` <br />State <br />O <br />EPA/Other <br />R <br />d. <br />State <br />EPA/Other, <br />J. Additional Descriptions Fo`rMaterials Listed Above <br />�- <br />K. Handling Codes For Wastes Listed Above <br />FR,jABLE ASBESTOS; CONTAINING. W l�S'rE <br />:.: <br />6. <br />C. <br />d. <br />15. Special Handling Instructions and Additional Information <br />24 HRS. ENERGENC i 1"2300-535-505 <br />BDC R f IA 765 SOUTiH A <br />��, � <br />AZCISt , f~f 7 '� n <br />q re'l�.j� nQ �3+. OjC.r ` r�Jt�..J ri� <br />EPA FEG IX -7,J HAW HOF-)'. S <br />BAAQ)MD 939 ELL.IS ST `SAN E^t<AN CB R BUILOEPSS <br />ASBESTOS REMOVAL F�ECaI�IE<EMHIT 40CFRb'I(BAGGED,SErUD 4•.LABELEL) <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the <br />contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, <br />marked, and labeled, and are in all respects in proper condition For transport by highway according to applicable international and national government regulations. <br />If I am a large quantity generator, I certify that I have a <br />program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br />practicable and that I have selected the rracticable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health <br />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 <br />available to me and that I can afford. <br />Printed/Typed Named <br />Signature t / _ <br />Month Day Year <br />T <br />R <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />e <br />A <br />Prinfed/ ed Name <br />T <br />Signature % j� <br />g <br />Month Day Year <br />P <br />1 C 11 `- S� ✓� <br />ice_.., <br />< o <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />R <br />T <br />Printed/T ed Name <br />YP <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />L <br />� % <br />20 Faci ity Owner or Operator Certification of receipt of hazardous materials covered,this/mo'fest except a meted Item 19. <br />T <br />led/Typed Nome J <br />/�: <br />Signaty e ,_ <br />orYh� Doy Year <br />Y <br />L( <br />DO NOT WRITE BELOW THIS LINE. o � <br />DTSC 8022A (4/97) <br />EPA 8700-22 1 Yellow: GENERATOR RETAINS <br />