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"a`tafe of California—Environmental Protection Agency ' <br />Form Appro , OMB No. 2050-0039 (Expires 9.30.99) See 16�truc ions on back of E <br />Please,point or type. Form designed for use on elite (12 -pitch) l er. i <br />O <br />N <br />W) <br />I\ <br />N <br />LO <br />ao <br />0 <br />o <br />a0 <br />cx <br />LL <br />F_ <br />2 <br />LL <br />t - <br />LL <br />V <br />C <br />Q. <br />V <br />LL <br />C <br />a <br />C <br />L <br />2 <br />t - <br />b• Department of Toxic Substances Control <br />DO NOT WRITE BELOW THIS LINE. cy <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 />1. Generator's US EPA ID No. _ Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />- <br />C- A 1., O O Q I y 3� q 3 <br />is not required by Federal low. <br />WASTE MANIFEST <br />1 7 0 1 4 <br />1°f 1 <br />3. Gc, rat rLa�ng Address <br />L2d32 <br />A. State Manifest Document Number q <br />HARTER WA1 SITE: SAME <br />9 66 .L O <br />STOCKTON, CA 95208 <br />209) 487-0490 <br />B. state enerofor s ID <br />�i Y H Q 3 8 0 2= 9 1 5 <br />A. Generator's Phone ( <br />S <br />5. Transporter 1 Com any Name 6. US EPA ID Number <br />I)DC—FALCU <br />C. State Transporter's ID <br />SPECIAL WASTE SERVICES CAR 0101 0.0 1 7 6 5 7 <br />D. Transporter's Phone —1 �E4 <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID <br />F. Transporter', Phone <br />9. Designated Facility Name and Site Address"' '-- — — 10. -US EPgiD Number----- - <br />G. 5tate FociLty's 113-- <br />FORWARD INC. — APPROVAL #5225520 <br />ClAl Di 9191017191 41 1. :,:1 3 <br />9999 SOUTH AUSTIN RD <br />H. Facility', Phone <br />MANTECA, CA 95338 C A D 9 9 0 7 9 =f 1 3 3 <br />(209)982-4298 <br />11. U.S DOT Descripti (including Proper Shipping Name, Hazard Class, ond-ID Number) <br />- <br />12. Containers <br />13. Total — <br />Quantity <br />14. Unit <br />Wt/Vol <br />I. Waste Number <br />No. <br />Type <br />a. <br />State 151 <br />R. Q. ASBESTOS, 9, NA 2212, PGI I I (Ni-iERU# 171) <br />EPA/Other <br />G <br />O o f <br />C ►t'I <br />Zoo <br />Y <br />N6. <br />State <br />E <br />R <br />EPA/Other <br />—� r�T ` Thi` F <br />A�—.. <br />T <br />c <br />'>, <br />State <br />°a <br />FEB 0 9 1998 i <br />EPA/Other <br />d. <br />B1T . <br />/B _.—. � <br />State <br />_ _ -- <br />EPA/Other <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes For Wastes <br />Listed Above . <br />FRIABLE ASBESTOS CONTAINING WASTE <br />c <br />d. <br />k <br />46 <br />.EMERGENCY <br />15. Special Handling Instructions and Additional Information 24 HI'S. 1-800-535-505-3. <br />BDC-FALCON 788 SOUTH AYON AZUSA, CA 91702 <br />EPA REGION -IX -75 HAWTHORNE ST.. SAN FRANCISCO., CA 94105 QB-REBUI ERS <br />ASBESTOS REMOVAL REQUIREMENT 40CFR81 (BAGGED,SEALED 9 LABELED) tZ ;�{� 5-2-5-52-0 <br />imarked, <br />16. GENERATOR'S CERTIFICATION: I herebydeclare that the contents of this consignment are full and accurately described above by proper shipping name and are classified, packed, <br />and labeled, and are in all respcts in proper condition for transport by highway according to applicable international and nationol government regulations. <br />If 1 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 economically <br />t practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health <br />S. OR, if I I have faith to my waste and select the best waste management method that is <br />and the environment; am a small quantity generator, made a good effort minimize generation <br />available to me and that I can afford. <br />Printed/Typed Nome g - j <br />Month Day Year <br />' <br />��_ <br />r� <br />t T <br />I <br />17. Transporter 1 Acknowled ement of Receipt of Materials <br />i p <br />RRe <br />Printed/Tye Name <br />Signature <br />Month Day Year <br />i 5 <br />J <br />o/ z� S 8 <br />P <br />8 <br />18. Transporter 2 Acknowled ement of Receipt of Materials ---- — -- --- - - - -- - - - - -- - -- - — - - - - -- - - - -—_ _- _ - <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />s E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />1 <br />20. F ili ' Owner or Operator Certification of receipt of hazardous materials co red bi thiygonifest ex 1, ate d i tem 19. <br />T <br />Pri e d ame <br />S' notur <br />th°Y ° <br />Y <br />DO NOT WRITE BELOW THIS LINE. cy <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 />