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a- Stpti c4talifornia—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039-IExpires 9.30-99) <br />Please print or type. Form designed for use on elite 112-nite61 <br />f <br />t <br />C <br />Y <br />04 <br />C\t <br />t F <br />C <br />C <br />a <br />C <br />C <br />CX <br />.4 <br />2 <br />C <br />Q <br />Z <br />LL <br />t - <br />Q <br />ii <br />;re. See Instructions on back of le 6. DeoartmentofTnv;r <br />DO NOT WRIT BELOW THIS LINE. <br />DTSC 8022A (4/97) <br />EPA 8700-22 <br />Yellow: GENERATOR RETAINS <br />-----UMIFORM HAZARDOUS 1. Generator's US EPA ID No. 't Manifest Document No, 2. Page 1 <br />1 <br />Sacramento, California <br />Information in the shaded areas <br />-------'WASTE MANIFEST <br />is not required by Federal law. <br />( <br />Of <br />3. Generator' am and M ili g Address A. State Manifest Document Number <br />��iJ/ s��7t°a �970 9 5 <br />.7y/�o�yf�/��tlwl C-�/� ,�,ff,r <br />u <br />5�6.. <br />s. /�'-(` B. State Generator's ID <br />) <br />A. Generator's Phone ( ,)cry <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID <br />� <br />BIIC <br />> <br />5fiEC I AL WASTE SERVICES <br />rans <br />D.' Tporter's Pho <br />j <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID <br />- <br />F-.' Transporter's Phone <br />9. Designated Facility Name and Site Address .� �S EPA ID Number, <br />A1eWoitL � <br />G. State Facility's 1D <br />FORWARD INC. a <br />f^ r <br />G 1 <br />9999 SOUTH AUSTIN RD <br />H. Facility's Phone <br />MANTECA, CA 95335 1 CAD Ql 9 3 719141 11 3 -:: <br />{cC+9i9 <br />j <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) - <br />12. Containers <br />13. Total <br />14. Unit <br />- <br />No. <br />Type <br />a. <br />Quantity <br />Wt/Vol <br />I. Waste Number <br />G <br />R. P. ASBESTOS, 9,- NA ,_21.t., F'GI I I (h�I� FRG(#171) <br />State <br />151 <br />EPA/Other <br />E <br />- <br />� <br />t <br />6. <br />State <br />E <br />_ <br />R <br />EPA/Other <br />A <br />T <br />State <br />O <br />R <br />EPA/Other <br />d <br />I <br />State <br />EPA/Other <br />J. Additional Descriptions for Materials listed A6ove <br />K. Handling Codes for Wastes Listed Above <br />FRIABLE t -SPEP ,-101 i,fsf'#�tFTiii�tE� I€ti3'FE <br />C. <br />d. <br />15. Special Handling Instructions and Additional Inlo'—hon <br />4 HR-. C�PIERGENCY 1--800-535-5053 <br />BBC- t -5 ,;- 7Sb SOUTH r- AGN AZUSA, GA 9170 <br />i EPA REGION IX -75 HAWTHORNE ST,- BAAQMD--939 ELLIS ST SAN FRAN CA <br />` <br />a . ASBESTOS REMOVAL REQU I ReMENT 41X FRE 1 • (BAGGED, SEALERS & LABELEb) <br />!I, llrbl,, lrl'rt <br />16. ,GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are Fully and accurately described above byproper 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 national government regulations. <br />IF I am a large q�ontiy generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have <br />practicable and that I have selected the <br />determined to be economicolly <br />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 mode a good faith effort to minimize my waste generation and select the best waste management method that is <br />available to me and that 1 can afford. <br />Printed/Typed Name r....._.. _ -_ ... <br />. <br />v �9 re ' <br />Month Day Year <br />it r-�;'- ., .. r.-•. <br />RT <br />_ <br />17. Transporter 1 Acknowled ement of Receipt of Materials ! s f <br />_ <br />A <br />P <br />Pri ted/T 'ped Name 2re/Do <br />Month Year <br />B <br />18. Transporter 2 Acknowleciement of Receipt of Materials <br />1 <br />E. <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />L <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered 6y#s nifesi a c -e t noted in Item 19. <br />T <br />Y <br />Printed/"Ty e/dlNammee . n <br />r r l/ r �i r <br />Si nature <br />9 a <br />/Month, �ay� ,Y�ar <br />DO NOT WRIT BELOW THIS LINE. <br />DTSC 8022A (4/97) <br />EPA 8700-22 <br />Yellow: GENERATOR RETAINS <br />