Laserfiche WebLink
California—Environmental Protection Agency <br />�ved OMB No. 2050-0039 (Expires 9.30.99) <br />oc type. Form designed for use on elite (12 -pitch) <br />rifer. <br />See Instructions on back o 4 e 6. <br />Department of Toxic Substances Control <br />DTSC 8022A (4/97) <br />EPA 8700-22 <br />DO NOT WRITE BELOW THIS LINE. <br />Yellow: TSDF SENDS THIS C(py <br />TO GENERATOR ITHIN 30 DAYS. <br />(Generators who subazardous wast or transport out-of-state, <br />produce completed cof this cond send to DTSC within 30 days.) <br />- -.aocramento, <br />UNIFORM HAZARDOUS <br />1. Generator's US EPA ID No. Manifest Document No. <br />2. Page 1 <br />C.aGtornia <br />Information in the shaded <br />WASTE MANIFEST <br />C A 4 A 0 Q 1191-3 O 5 <br />areas <br />is not required by Federal law. <br />3. Generator's Name and Mailing Address t, <br />t <br />tot t <br />S-2 S-5-20 <br />A. State Manifesf Document Number <br />OB REBUILDERS <br />2325 CHARTER WAY SITE: SAME <br />�y <br />-q R A q -7 1 ! 01 J <br />STOCKTON, CA 95206 <br />8. State Generator's ID <br />h <br />t. <br />4. Generators Phone <br />' 209 467-0490 <br />H t <br />N <br />h <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />.: yl 1 <br />C. State Transporter's ID <br />0o <br />BDC—FALCON <br />O <br />SPECIAL WASTE SERVICES c <br />1 F <br />D. Transporter's Phone <br />! <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />)816)969-i:384 <br />J <br />E. State Transporter's ID t; <br />J <br />9. Designated Facility Name <br />F. Transporter's Phone <br />- <br />and Site Address 10: US EPA -ID Number- <br />(I. State Facility's ID <br />FORWARD INC, — APPROVAL #52'5520L <br />9999 SOUTH <br />t 11 , <br />AUSTIN RD <br />H. Facility's Phone' <br />MANTECA, .,CA 95336 Cl1- D 9 7 9 1 <br />- - <br />(209)982-4298 <br />'y <br />11, US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />14. Unit <br />No. <br />Type <br />a. <br />Quantity <br />Wt/Vol <br />I. Waste Number <br />�- <br />G <br />R. 0. ASBESTOS, 9, NA 2212, PGI I I (NAERG#171) <br />State 151 51 <br />EPA/Other <br />E <br />O j <br />C <br />U D <br />N <br />b <br />OOD <br />E <br />t <br />State <br />AEPA/Other <br />00 <br />O <br />c. <br />State <br />R <br />EPA/Other <br />ac <br />LU <br />t - <br />d. <br />Z <br />State <br />LU <br />U <br />LU <br />EPA/Other <br />try <br />Z <br />O <br />J. Additional Descriptions for Materials Listed Above <br />- <br />K. Handling Codes for Wastes Listed Above <br />g <br />LLJ <br />FRIABLE ASBEST•CS CONTAINING WASTE <br />'�." 0s <br />J <br />Q <br />-. <br />C. <br />d. <br />- <br />0 <br />15. Spec; Handling Instructions and Additional Information <br />P= <br />_ <br />c4 HRS. EMERGENCY 1-800-5365-5053z Br)C—FALCON 766 SOUTH AVON AZUSA, CA 91702 <br />= <br />�- <br />Ef'A REGION IX -75 HAWTHORNE ST.. SAN FRANCISCO CA 94105 QB REBUILDERS <br />`ASBESTOS REMOVAL REQUIREMENT 40CFR61(BAGGED.SLALED & LABELED) <br />-J+ <br />la1 <br />16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and notional government regulations. <br />J <br />J <br />N <br />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 economical[ <br />practicable and that I hove <br />y <br />selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and Future threat to human health <br />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 <br />available to me and that I <br />O <br />can afford. <br />V <br />Printed/Typed Name <br />1'_-' <br />Sia �t�e <br />Month Day Year <br />T <br />R <br />17. Trans Transporter 1 Acknowled Acknowledgement of Recei t of Materials <br />- <br />W <br />2 <br />w <br />N <br />S <br />Prince yd qm h /1 n <br />( -- fJ/�l lt,- G; /,�jt/�, L� <br />/ <br />Signature <br />Month Da Yeor <br />Y <br />D 3 O <br />0 <br />0 <br />18. Transporter 2 Acknowled ement o{ Recei t of Materials <br />ys <br />T <br />E <br />Printed/Typed Nome- <br />Signature <br />Month Day Year <br />Q <br />R <br />: `%j <br />I <br />J <br />19. Discrepancy Indication Space <br />Z <br />- <br />F <br />A <br />; <br />C <br />I <br />L <br />I <br />ili Owner or O era or CertifioafltY$' cei t of hazardous moteriaT3`mvere" this manifest except as noted in 19. <br />YTyped <br />N e kor Signature <br />#in <br />DTSC 8022A (4/97) <br />EPA 8700-22 <br />DO NOT WRITE BELOW THIS LINE. <br />Yellow: TSDF SENDS THIS C(py <br />TO GENERATOR ITHIN 30 DAYS. <br />(Generators who subazardous wast or transport out-of-state, <br />produce completed cof this cond send to DTSC within 30 days.) <br />