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�$jate of dlifornio—Environmental Prptection Agency F6ctq Ap roved OMB No. 2050-0039 (Expires 9.30-99) See Instructions on back of -6. o Please print or,lype. Form designed for use on elite (11 -pitch) ar. UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. WASTE MANIFEST . C A J. O Q U 1 q.3 O 0 1 3. Generator's Name and Mailing Address QB RREBUgqI LDERS��.l!gqy TCKONRTEA 95�@6 SITE: SAME 0 4. Generator's Phone ( 209) 467-0490 cV 5. Transporter 1 Company Name 6. US EPA ID Number to 0D BDC-moi 0 k� SPECIAL WASTE SERVICES C A R 0 0 1 7, 7. Transporter 2 Company Nome _ - _8. US. EPAL ID Number-._—_ J A. State Department of Toxic Substances Control Sacramento, California i, , 2. Page 1 Information in the shaded areas is not required by Federal low. 1 of 1 tst Document Number 96617018 B. State Generator's ID flYHQ36024f 9 ! 5 C' Slate Transporter's ID D. Transporter's Phone - E. State Transporter's ID'" F. Transporter's Phone 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID iD2FORWARD INC. - APPROVAL #525520 r, '4 � 9999 SOUTH AUSTIN RD H. Facility's Phone r-I�=MANTECA, CA 95336 1 CAD 19191017191.411131 12. Containers 13. Total :oU 11. US DOT Description )including Proper Shipping Name, Hazard Class, and ID Number) No. Type Quantity .OZ a. G R.Q. ASBESTOS, 9, NA 2212, PGIII (NAERG#171) E b o� Cm 92 00 aC E v R v A o T co O R ce LU H Z LU V U-1 V) J. Z __.O _ 0- V) V) W ae Q Z 0 15 Q Z LU t - J 16 Q - v N O Pri V Z LU TR 17 oc 4 Pri w HS w P SE? 0 3 193 1- ( 209) 982-4296 14. Unit Wt/Vol L Waste Number State 151 EPA/Other State EPA/Other State EPA/Oilier State EPA/Other Additional Descriptions for Materials Listed Above - - K. Handling Codes for Wastes Listed Above 03. FRIABLE ASBESTOS CONTAINING WASTE r d. Special Handling Instructions and Additional Information BDC-FALCON 766 SOUTH AYON AZUSA,2CAHRS991702MERGENCY 1-800-535-50513 10 EPA REGION IX -75 HAWTHORNE ST. SAN FRANCISCO CA 94105 QB REBUILDERS mss'%p ARRESTORu f r 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, packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and notional government regulations. If I am a large quontily generator, I certify that I hove a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically 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 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 available to me and that 1 can afford. nted/Typed Nome Signature_ i Month Day Year l 7rl 6 -it, j, L/I- . Transporter 1 Acknowledgement of Recei toS Materials nted(%.d Name v Signature Month Day Year U 0 18. Trans orter 2 Ac R T Printed/Typed Name w E N R U 19. Discrepancy Ind! Z F A C L 1 20. Facili ne e T Printed/Typed o e, Y DTSC 8022A (4/97) EPA 8700-22 � 2-1 3 150 rd ement of Receipt of Materials Signature Month Day Year Space / - - i � altar Certifica io of receipt of hazardous materials covere by is manifest except s ted in Item 19. OSignature ^ lv�o �D eq UA�U l DV NOT WRIT BELOW THIS LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. (Generators who submit hazardous waste for transport out-of-state, produce completed copy of this copy and send to DTSC within 30 days.)