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� B 6• '"&V Sacramento,California <br /> pnvironmeMal Protection Agency �� 6,, " See Instructions on back of peg <br /> B No.2050-0039(Expires 9.30.96) Information in the shaded areas <br /> form designed for use on elite(12-pitch)type 2. Page 1 t <br /> ' <br /> or <br /> US EPA ID No. Manifest Document No. is not required by Federal law. <br /> 1. <br /> UNIFORM,HAZARDOUS of <br /> FEST <br /> WASTE MANIP.FEST ra <br /> / ,, A. tate Manifest Document Number <br /> 3. Generator's Name and Mailing Address SAME — <br /> 8:REBO I LEERS B. State Generator's ID i <br /> �32g 11EST CHARTER WAY <br /> STOCKTON, CA 93206' <br /> A. Generators Phone (2091-467-0490 C. State Transporter's ID <br /> • 6. US EPA ID Number <br /> S. Transports company Name OO v j �" /` J D. Tronsporter`s Phone », <br /> C A - E. State Transporter's ID <br /> pa Nome 8. US EPA ID Number I <br /> � 7. Trans rter 2 Com ny F. Transporter's Phone <br /> C. <br /> U G. State Facility's ID <br /> Q 10. US EPA ID Number <br /> Z 9. Designated Facility Nome and Site Address <br /> dY <br /> -� �. _ -- -- H. Facility's Phone .. <br /> b'3 p FORWARD INC. : l k <br /> u- ;'9999 SOUTH RUST I N RD 1 CAD 9 9 0 ` 4. 1 '� " 13. Tatar 1 a. unit - <br /> �a "TECA;:�CA-95336 12. containers t <br /> T Quantity Wt/Vol 1. Waste Number <br /> ham,/U - No. State <br /> . <br /> 11: US DOT Description(including Proper Shipping Name,Hazard Cross,and ID Number) --- .-- -- ' <br /> LO Z1 �/ <br /> � -�._a.-���=_--.. -•- _._ (���7 "�'� ,,. - •- � EPA/Other k <br /> R.Q. ASBESTOS, 9 Nf i^c PG III L j1') o l <br /> State <br /> G <br /> C'4E _ EPA/Other <br /> a00 b r <br /> N <br /> ao <br /> State <br /> 6 } <br /> A � � EPA/Other <br /> T C. <br /> 00 <br /> O State <br /> R ` - <br /> w [V PA/Other <br /> I- d l_V <br /> Z - 1 <br /> LU <br /> U s# '....1 �a rt`x.ti:7�4":;; w:Ci:7 4'J'r`r3,.r �, t i.., ._ <br /> t t..,...•rr,. �,.: .. -"' Handling Codes for Waster Listed Above , <br /> N forMateria)s.listedAbore' <br /> ZO 1,.Additiocwl-Des-c-IG w"t <br /> 1 w r prrt'1 <br /> C. <br /> �--- <br /> Z 4 HRS. EMERGENC`! �`�� ,tiw. <br /> 15. special Handling�nstructions and Additional Information ` C 9174 <br /> Q BDC. :-I�+ � 65 S�lU o H A i�)Pl..,, - 4 Q.B. REBU I LDERS <br /> Z - SEALED AI'!F? LABELED) <br /> _ EF>�t.-RECTION I X <br /> ZPAUMD 939 ELLIS ST:` SF- CA <br /> M: A5BESTgS RRNpVgI_ REGUIREMEPlT 40 <br /> CFR'61 <br /> (BAGGED, e+✓ <br /> OR'S CERTIFICATION: I hereby declare that the conten?F too Ircable international°nd non°nal government regulations. <br /> of this consignment are fully and accurately described above by proper'shipping name and are Bassi <br /> 16. GENERAT rt b highway according PP <br /> Q packed,marked,and labeled,and are in-all lrrespects in PfOPef condition for transpo Y. rated to the degree I have determined to be <br /> U <br /> ture <br /> If 1 am a large quantity 9 ract cable method of treatment,storage,or dispo fdrth effo to m nim ze my waste genetatrion and select thend best <br /> uaMi generator,1 certify that 1 hove a program in place to reduce the volume and toxicity of wavailable to me whidi minimizes the present a <br /> aste gene fi� <br /> -� I have mode a good <br /> -' economically practicable and that I have selected ill am o small quantity generator, Year <br /> threat to human health and the environment;OR," . Month Day <br /> an Q C/ <br /> � waste mono ement method that is available to me and that 1 can affo�� f`f <br /> Q Printed/Typed Name e'er <br /> / (� c A/ / Year <br /> U � �L K'f�A AI.0� tY t� /` ./'') �' Month Dal' � <br /> Z T 17. Trans iter 1 Acknowled ement of Recei t of Materials ^ �%�i / i 0y- <br /> wlj� <br /> A <br /> Printed/Typed Name7. �a <br /> JY/1 V F,.( ,.•- -i' Year <br /> w O /° j! Month Day <br /> p 18. Trans iter 2 Acknowled ement of Re of Materials S19 / // <br /> j <br /> I u.. T Printed/Typed Name <br /> O E <br /> It <br /> I N 19. Discrepancy Indication Spacef <br /> ! i <br /> UIF <br /> A �.. <br /> ZC; - Year <br /> J Month Day <br /> L rotor Certification of recei t of hazardous mates glrwtuf red b this manifest exce t as noted in Item 1 <br /> 1 20. Facil' Owner or <br /> I T Printed/Typed Name t` <br /> Qlh1 r \� <br /> If I r <br /> DO N07 WRITE BELOW THIS LINE. <br /> I mWTA <br /> YS <br /> Yellow: TSDF SENDTHIS <br /> Cot P -of-state, <br /> A, <br /> (Generators hGENERATOR transport out <br /> produce completed copy of this copy and send to DTSC within 30 days.) <br /> IDTSC 8022A (1/95) <br /> IEPA 8700-22 <br />