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Fprp.Appr2od OMB No. 2050-0039 (Expires 9.30-99)See Instructions on back ofa e 6. <br />P 9 Department of Toxic Substances Control <br />P mt or type. Form designed for use on elite (12 -pitch) typewriter, <br />qz <br />t� <br />t <br />till <br />00 3 <br />CT) n <br />C <br />ccocCN <br />CN <br />C <br />C <br />cc <br />oc <br />LL <br />F- <br />2 <br />LLL <br />L <br />C <br />t - <br />u <br />L <br />s <br />u <br />c <br />L <br />L <br />L <br />L <br />k <br />DO NOT WRITE BELOW THIS LINE. <br />1 <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 <br />rotor's US EPA ID No. Manifest Document Nr <br />2. Page 1 <br />Information in the shaded areas <br />WASTE MANIFEST <br />is not required by Federal low. <br />r L� r L '" 1 <br />1 of I <br />3. Generator's Name and Mailing Address <br />QB REBUILDERS <br />A. State Manifest Document Number-1 <br />9 3 5 ;. ' <br />2325 WEST CHARTER WAY SITE: SAME <br />B. State Generator's ID <br />STOCKTON, CA 95206 <br />A. Generator's Phone ( 2013) 467-0490 <br />111 YJ fil 01316101214191 1 --, <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID <br />BDC SPECIAL <br />D. Transporter', Phone <br />WASTE SERVICES ClAlRI 0101 C� 01117161517 <br />(6215) `_ 59-1.,84 <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID <br />F. Transporter's Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number G. Statecility'l ID <br />O 0 o <br />FORWARD INC: - APPROVAL #525 eO (4;344 a 1 <br />9999 SOUTH AUSTIN RD C ia, L O OU � Q H. Facility's Phone <br />MANTECA, CA 95335 G <br />12. Containers 13. Total 14. Unit <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) No. Type Quantity Wt/vol I. Waste Number <br />a. <br />State <br />G <br />R. Q. ASBESTOS, 9, NA 2212, PGI I I (raAER13#1 r 1) <br />' <br />Q <br />� <br />EPA/Other <br />Nb. <br />State <br />REPA/Other <br />A <br />J <br />c. <br />State <br />O <br />F� <br />EPA/Other <br />R <br />APRA <br />d _ I <br />State <br />EPA/Other <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes <br />Listed Above <br />b. <br />r r tr E SID OS n n t s -. <br />rta�'tE��w t -ti, : S`I` ,� 1=,�riiTf-tI�!II<a ,1I�,5-i`tw <br />- <br />c. <br />d. <br />15. Special Handling Instructions anndd Additional Information 24 �• R3. 11—o$fZ 0-535-5053 <br />BDC AL 766 SOUTH AY 3A. 91700 <br />qE{%(ERGE (NCY <br />M <br />t SRAN �}� CpC <br />E PA EG ( <br />�( SuFAD <br />iAW�NORM T43.�-),oA9v,5 ELLIS�S�;"5A�4 QB R Bid I S <br />ASBESTOS REMOVAL REQUIREMENT 40CMI (BAGGED,SEALED & LABELER) <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above broper shipping name and are classified, packed, <br />y p <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 program in place to reduce the volume and foxiciy of waste generated to the degree I have determined to be economically <br />future threat to Kumon health <br />i <br />practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and <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 />Pri 1 /Ty(pee Nome <br />/ 1"Signat'ure,. <br />.. <br />Month /Day Year's <br />Citi <br />�7 <br />O C' :y7__ 7__ _"- <br />/� <br />f� <br />1 T17. <br />Transporter 1 Acknowledgement of Receipt of Materials <br />R <br />i p <br />Is <br />Printe / pea Name <br />le, <br />Signal a <br />Month Day Year <br />a U <br />1 <br />�� f s�� <br />191 <br />8 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />i T <br />Printed/Typed Name <br />Signature <br />Month Day Year ' <br />1 E <br />? R <br />j19. <br />Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />1 <br />20. Foci ity Owner or Opprotor Certification of receipt of hazardous materials covered by this maniWst —except as noted in Item 19. <br />TPrinted/Typed <br />Y <br />Na a <br />k_S <br />Signatur <br />nth e r 1 <br />14,r <br />DO NOT WRITE BELOW THIS LINE. <br />1 <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 />