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• `(ronmeMal Protection Agency Jam.�Y^+..• ^• �• J.•.^.,�- ----—--—--� L ��'`�� ( j No.2050-0039(Expires 9.30.96) See Instructions on back of Ie 6 �Department of Toxic Substances Control tee'. Form designed!or vse on elite(12-pitch, niter. Sacramento,California UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas is not required by Federal law. WASTE MANIFEST' '"11 1 ! -9 31 4 .3 0 1 of 3. Generator B ' jJgmq p(i�Mgi1�i Address- -.. SAs fiA. State Manifest Document Number Ln s t,ji(Jll. I•t d_ - ,.:'' ^ 2325' WEST-CHARTER WAY N STOCKTON, CA.95206. B. State Generator's ID rt) 4. Generator's Phone(209r467-+ 490 I C 1 I:C I G 1:-" O 5. Transporter 1 Company Nome 6. US EPA ID Number C.State Tronsporter's ID bac . F.ALC�v s, UJ-5, po 0 01 31 �S -- j D. Transporter's Phone 1 y Q7. Transporter 2 Company Name 8. US EPA ID Number 'E. State Transporters ID U •meq F. Transporier's Phone Z i 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID (o oFORWARD .INC. J 9999 SOUTH A�1 Y N RD H. Facie ty's Phone a MANTECA, CA 95336 CAD 19 19 10 1719 141113 13CAD - - 11. US DOT Description(including ProShi Name,Hazard Class,and ID Number 12. Containers 13. Total 14. Unit Z Ptan( g � ) No. Type Quantity Wt/Vol I. Waste Number state! gs•'i 3 G R.Q. -ASBESTOS,` 9 NA221iR RG III (ERG 31) EPA/Other 000 N b t r,. �'. yt qr �y. w t r U ` Stae -. C'4 R r.1/ _.r.i ti- Frf ". EPA/Other o A 00 T C. State O of R EPA/CRher w t— Z d• State LU N '. APQ C 1997 EPA/Other Z J Additanol Descriptions for Materials Listed Above t 11 a ' y K. Handling Codes for Wastes Listed Above o (�, b. ---------------- C. - c. d. - O 15. l-Handl ng I trydioos antd ormation < 766 SOUTH AYON�AZUSA, CAE1-80g-5�5-5Qt53at 91702Y �. Y^ Z W EPA REGION IX. 8AA@MD"'939 ELI-15 ST. SF CA Q.B. REBUILDERS ' ~ ASBESTOS REMOVAL REQUIREMENT 40 CFR 61 (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, Vpacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. If I 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 a_ 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 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 management method that is available to me and that I can afford. O Printed/Typed Name Si Month Day Year �� N�c til , 1,ic/ z < C 3 C1 17 w g 17. Transporter 1 Acknowledgement of Receipt of Materials wS Printed/ y am ^ G� $ig m L ` Month /�gy Near P w 0 18. Transporter 2 Acknowledgement of Receipt of Mater' R LL T Printed/Typed Name Signature Month Day Year O E It N19. Discrepancy Indication Space Q F U A Z C I L 1 20. Facility Owner or Operator Certification of receipt of hazardous material o redXy this manifest except as noted in Item 19. rfVlj 4 -Day C DO NOT WRITE BELOW THIS LINE. Yellow; TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. DTSC 8022A (1/95) (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.)