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C <br />u <br />W <br />r <br />C <br />v <br />O <br />C <br />C <br />a <br />Lri <br />003 <br />0) <br />C <br />a: <br />oc <br />4 <br />C <br />C <br />cc <br />M <br />LL2 <br />LL <br />a <br />Z <br />Ci <br />a <br />Z <br />LU <br />a <br />U <br />N <br />0 <br />Z <br />/ ental Protection Agency % /1 <br />2050-0039 (Expires 9-30-99) ft 0 See Instructions on back ofa e 6. <br />�. Form designed for use on elite (12-pitchl t oewriter. P g Department of Toxic Substances Control <br />6 <br />DO NOT WRITE BELOW THIS LINE. r <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />DTSC 8022A (4/97) (Generators who submit hazardous waste for transport out-of-state, <br />EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />UNIFORM HAZARDOUS enerotor's US EPA ID No. Manifest Documen 2. Page 1 Information in the shaded areas <br />WASTE WNIFEST is not required by Federal law. <br />01011 ti 7 q { "7 1 of f <br />3. Generator's Name'dnd Mailing Address yA. <br />State Manifest Document Number <br />013 REBUILAERS <br />t <br />2325 NEST QHART�R i� A-V SITE: SAME °.. <br />`'T OCKTON, CA 9520' <br />B. State Generator's ID . <br />• <br />A. Generator's Phone ( i_'ft19) tflCrl'"' ►�(� f{ Y t� �i IL 2141911151 <br />1 91 <br />J <br />5. Trarnsrporterl Company Name - 6. US EPA ID Number - <br />C. State Transporter's ID <br />BDC SPECIAL <br />- <br />' <br />i4ASTE SERI ICES2 1 7 6 5 CAIR1 i�1 <br />D. Transporter's Phone <br />7. Transporter 2 Company Name17 <br />lJr3�)�7"1.a <br />- 8. US EPA ID Number <br />E. State Transporter's ID <br />F. Transporters Phone <br />9. Designated Facility Nome and Site Address ` �^ L2` 1n0. US EPA ID Number <br />G. State Fac li 's ID <br />FORWARD INC. — APPROVAL ✓may = �4 <br />'3999 SOUTH AUSTIN RD <br />MANTECA, CA 9-5336 <br />.Facility'sPone - <br /># <br />(209) 942•-4c38 <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13 Tocol <br />14. Unit <br />No. <br />Type <br />Quantity <br />Wt/Vol <br />I. Waste Number <br />a. - <br />R. ASBESTUS, 97 NA -2-212, PGI I I (NAER5J1171) <br />State 1�J1 <br />EPA/Other <br />E <br />r } Q <br />N <br />b. <br />State V <br />E <br />R <br />.. <br />EPA/Other - <br />A <br />C. <br />"�'1.'-'^ <br />l.r LVED <br />State <br />R <br />'�: r <br />EPA/Other <br />d. f LU <br />State <br />I' '•lrT. <br />EPA/Other <br />J, Additional Descriptions For Materials Listed Above - - <br />K. Handling Codes for Wastes Listed Above <br />FRIABLE ASBESTOS CONTAINING WASTE <br />a �3 6 <br />c, <br />d. <br />15. Special Handling Instructions and Additional Information 24 HIRS. '.l" IEf G El',IC�: 1 8lr0-'535--C.i><�.3)3 <br />� <br />'� BDC �IP€CIAL 1766 SIOU HH A'rON aZU—A, CA 17 c q <br />G qI'�,'`5HAWKUf�hJY�5�i1 <br />F n/ y� <br />' ��G!t�i��9 1i�L�iS�'ST��F�h� ��!� �UB <br />.ISS' RG <br />ASBESTOS REMOVAL REQU I REME?dT 40CFR6r 1(BAGGE-D, SERL�D d LABELED) " . <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are Fully and accurately described above by proper ski Ping 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 notional government regulations. <br />If I am a larg, 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 <br />practicable and that I have selected the <br />practicable 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 Nome % Signature - � Month Day Year <br />© ( i( 2V1/Q ©0 <br />121111R <br />T <br />17. Transporter 1 Acknowled ement of Recei t of Materials / % <br />NPri <br />a Typed Name <br />Signature <br />Month Day Year <br />S <br />P <br />c <br />YJ Cf <br />0 <br />18. Trans orter 2 Acknc enient of Receipt of Materials <br />ERPrinted/Typed <br />ome <br />N <br />Signature <br />Month Day Year <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />L <br />i <br />20. Focili Owner or Operator Certification of receipt of hazardous materials covered'b-)this nifest except as noted ' "Item 19. <br />T <br />Y <br />Prin / yp d Name <br />Y <br />Si Lure <br />n Dar <br />I <br />}} <br />DO NOT WRITE BELOW THIS LINE. r <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />DTSC 8022A (4/97) (Generators who submit hazardous waste for transport out-of-state, <br />EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />