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C <br />ur <br />CISn <br />LC <br />C <br />M-_4 <br />00 (, <br />LO <br />�3 <br />n <br />C <br />x <br />oc <br />V <br />N <br />C <br />00 <br />tY <br />W <br />t— <br />Z <br />W <br />U <br />W <br />a <br />U <br />J <br />a <br />N <br />EV <br />R <br />Z <br />W <br />O <br />od <br />W <br />W <br />LL <br />O <br />W <br />N <br />a <br />U <br />�olifomia—Environmental Protection Agency <br />/Approved 0481Wo. 2050-0039 (Expires 9.30.96) \.; See Instructions on back O, a 6. Department of Toxic Substances Control <br />print or type. ° .Form designed for use on elite (12 -pitch,, _ iriler. Sacramento California <br />DO NOT WRITE BELOW THIS LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />DTSC 8022A ()/95) (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 />I. Generators US EPA ID No, ' Manifest Document No. 2. Page 1 <br />Information in the shaded areas <br />WASTE MANIFEST <br />is not required by Federal low. <br />C C ®0 12 f 0 9 31 41 5 3 1 1 of <br />- <br />Address <br />'3, Generator's Name and Mailin SAME <br />Q. 8. REBU I LDERS� <br />Stare Manifest Docs rent <br />, tuber <br />, <br />2325 WEST 'CHARTER WAY. <br />STOCKTON, CA 95206 <br />fi stars Genaraiors ID <br />_ <br />4. Generators Phone (209r467-0490 <br />s. Transfer I Comparry erne b. US I m —•(D6 <br />e Transporter's ID <br />e, A - Unsporter's <br />Phone <br />7. Transporter 2 Company Name 8. US. EPA ID Number <br />e Transporters ID <br />sperter's Phone - <br />- <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />- <br />G. State Facility's ID <br />. <br />FORWARD INC. <br />t: ;) <br />_I L! <br />9999 SOUTH AUSTIN RDH. <br />H. Foaiit/s Phone <br />MANTECA, CA. 95336. ; ;- C A' 09 <br />, <br />117 US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12• Containers <br />13. Total <br />14. Unit <br />No_ <br />T <br />Quantity <br />Wt/Vol <br />I. Waste Number <br />a. 4,1 %Z Q t 7. / <br />- <br />State <br />- R.Q. ASBESTOS, 9 NA2212' PG ' I I I teffi lit <br />`- <br />EPA/Oilier <br />E <br />s / <br />/� 47 1 <br />C / <br />11 <br />N <br />b' <br />State <br />E <br />n 9 <br />R <br />' j <br />- <br />EPA/Other <br />A <br />IUJJ <br />o <br />�. _ JUN 2f 6 1997 <br />State <br />R <br />EPA/Other <br />d. <br />State <br />_ <br />EPA/Other <br />- <br />J.:Additional-Descriptions for -Materials listed Above .. K. Handling Codes for Wastes -Listed Above - <br />b. <br />JJ <br />c• <br />d. — <br />15. Speciar rW' p .1 - Information 24 HRS. EMERGENCY 1-800-535-5053 <br />BDG I-n__I ti C�3-11T9C' 766 CA -,91702 <br />EPA REGION' IX :'BAAQMD? ;- 93^ ' ' • AT FCA` - Q. B. REBUILDERS <br />APP,Uw� S�SSzc7 <br />ASBESTOS., REMOVAL REQUIREMENT 40 C>`R`ih (BAGGED, SEALED AND LABELED) <br />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, <br />packed, marked, and labeled, and are in all respects in proper condition, for tronspod by highway according to applicable international and national government regulations. <br />If I am a large quantity generator, I certify that 1 have, -a' progra'm in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br />economically practicable and that I hove selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future <br />threat to human health and the environment; OR, if I am a small quantity generator, I have made a good faith ort tomi ' ze my waste generation and select the best <br />waste mann ement method that is available to me and that 1 can afford. Z / <br />[Pri {/Ty d Name (� p7 <br />r re / _ <br />Month <br />Al j e j �C, [�Yeac57 <br />' <br />t t(/ iC. ✓ T <br />T <br />R <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />R <br />N <br />Prin*f/*,ped. <br />Nae <br />Vt��m <br />Signature /.�// <br />Month Day ear <br />S -717 <br />S <br />P <br />1 <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />R <br />R <br />Printed T d Name <br />/ YPe <br />Signature s <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />` <br />120. <br />FocilitvOwner or Operator Certification of recei ' of hazardous mate covered• this monifesKexc'eVosi noted in ftew09. <br />T <br />Y <br />Pri �TY \ m�l7r� �%L. . <br />V <br />r t � / <br />� <br />DO NOT WRITE BELOW THIS LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />DTSC 8022A ()/95) (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 />