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!7 � <br />�3 <br />tV <br />O <br />00 <br />00 <br />v <br />N <br />O <br />OD <br />W <br />LU <br />Z <br />W <br />V <br />w <br />o <br />0 <br />a <br />uj <br />w <br />d <br />N <br />EX <br />-y O <br />V <br />Z <br />I <br />a: <br />Lu <br />w <br />LL <br />0 <br />w <br />N <br />d <br />U <br />I� <br />r <br />/o mental Protection Agency v r <br />i4o. 2050-0039 (Expires 9-30-94) ' _ S@@ IflSf(UCf10n5 011 back of page 6. - Deportment ofT xvt Substances Control <br />Form designed for use on elite (12 -pitch) typ --r. Sacram o, California' <br />HAZARDOUS 1. itor's US EPA ID No. Manifest Document "No 2. Page -1 Intormation in me snaaea areas <br />is not required by Federal law <br />.UNIFORM <br />WASTE MANIFEST 2 �' 7 9 2 5 1. 11 of . 1 <br />r14 lo (W)ljol <br />f � <br />3x Generator's Name and Mailing Address A State Manifest Document Number .. <br />CVA <br />h.3-,LC5 Q v-,yt �Y 4"�u'� B. State Generafor's ID - - <br />. V <br />� <br />4. Ge'1ierrat7orrs"Phone <br />U <br />5. Transporter 1 Company Name 6. US EPA ID Number_ _ / <br />C. State Transporter's ID <br />D. Transp orter's Phone <br />t:$znta,, <br />ra <br />BDC GAD98 1 455520 <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transparier's ID <br />-- <br />Transporter's"Phone- <br />1 <br />9. Designatgd Facility Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />is P 9 9 9 0 7 1314 1 1 1' <br />FORWARD INC. <br />H. Facility s Phone <br />(� ` > 3 '= ` - <br />9999 SOUTH AUSTIN RD <br />4 1 3 3 <br />MANTECA, CA 95336 CAD 9 9 0 7 9 <br />. . <br />12. Containers <br />13. Total <br />14. Unit <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />Quantity <br />Wt/Vol <br />I: Waste Nurnber <br />No. <br />Type <br />State k 5 1 <br />/ <br />R. Q. ASBESTOS, 91 NA2212 pG III . t' �A E' I � ' � <br />EPA/ether. <br />Dig , <br />01 Q a 12 <br />E <br />State <br />N <br />E <br />b. <br />1 <br />RECEIVE* <br />EPA/Otfier. <br />.• <br />A2 <br />_ <br />StateAUG. <br />T <br />c. U I <br />. . <br />EPA/ her <br />R <br />BY: <br />State <br />d. <br />1 <br />11 I I <br />EPA/Other <br />K. Handling Codes for Wastes Listed:. bo <br />' <br />- <br />)- Addition., Descriptions for Materials Listed Above -.., <br />CALIFORNIA REGULATED >!AS•TE 01--J_.Y d <br />C. - <br />15. Special Handling Instructions and Additional Information 24 fI'IMERGENCY 1-8f,40-53575053... <br />. •-••t• <br />BDC SERV I CES, INC 766 SOUTH AVON AZUSA 91702 <br />-E-- S CA <br />,-EPA REGION IX <br />ASBESTOS REMOVAL REQUIREMENT 40 CFR 61 (BAGGED SEALED AND LABELEDr n fsz <br />described above 6y proper shipping name and are class <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately <br />for by highway according to applicable international and notional government regulations <br />packed, marked, and labeled, and are in all respects in proper condition transport <br />in to reduce the volume and toxicity of waste generated to the degree I have' determined to be' <br />if 1 am a large quantity generator, I certify that I have a program place <br />and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present, and future <br />waste, and select the best <br />economically practicable generation <br />threat to human health and the environment; OR, if 1 am a small quantity generator, I have made a good faith effort to minimize my <br />waste management! method that is available to me and that I can afford. Month Dai' Year •: <br />.. ... <br />Printed/Typed Name; e r "'19 I.A <br />C 11-1 <br />T <br />17. Trans orter 1 Acknowledgement of Receipt of Materials <br />R <br />A <br />Signature <br />Printed/ ed Name /} <br />"�-Dcy <br />S <br />`` !'T <br />P <br />0 <br />18. Trans orter 2 Acknowled ement of Recei t of Materials <br />7 <br />Printed/Typed Name - Signature <br />.E <br />R <br />19. Discrepancy Indication Space ; <br />1' <br />A <br />ry' <br />C <br />L <br />1 <br />20. Focili Owner or Operator Certification of receipt of hazardous materials c red is manifest / e t ed in Item 19. Mo T 'y ' <br />T <br />Pr' ed�/Typed Name Sig re <br />UV IVV I VVKI I C DCL%XWV is— <br />Yellow: <br />sn✓Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS, <br />(Generators who submh hazardous waste for transport out-af-ftate,. <br />produce completed copy -of this copy and send to DTSC in <br />EPA 87022A 30 days.) <br />�+ DTSC• 6022A (9/93) with <br />