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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000040958 1 (800)359-4555 1 004618133 J J K <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> Stockton Unified School District Weber Tech <br /> 1944 N. EI Pinai Drive 302 W.Weber Avenue <br /> Stockton CA 95205 Stockton CA 95203 <br /> Generator's Phone: 202 233 7Q45 1 1 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> APC Contractors,Inc. 4606 N.Bendel Avenue Fresno Ca 93722 CAD 120804497 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Forward, Inc.Landfill <br /> 9999 Austin Road <br /> Manteca CA 95336 CAL000190080 <br /> Faclity's Phone: 982 4298 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> and Packing Group(d arm,)) 13.Waste Codes <br /> HM No. Type Quantity Wt.Nol. <br /> 1. RQ, ASBESTOS, 9, NA2212, PG111 (ERG 171) BA Y 151 N/A <br /> Z 2. <br /> W <br /> C9 <br /> 3. <br /> 4. <br /> 14.Specie-#"ig Instructions and Additional Information <br /> Projct: Weber Tech (29.079) <br /> Prole: 753310 <br /> 15. GENERATOIrSfOFFEROR'S CER71MCATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> mar ked and labeledfplacerded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,i om*that the contents of this consignment conform to the terms of the attached EPAAdknowledgment of Consent <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(d I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generators=erors PrintedlTyped Name Signature Month Day Year <br /> 16. ntemational Shipmdnfs..i : = . <br /> Z Transporter signature(for exports only❑Import m U.S. ❑Export from U.S. Port of Dat g <br /> leavi /exit <br /> U.S.: <br /> 17.TratmporWAdmowledgment of Receipt of Materials �«• ". <br /> Transporter 1 Printed(Typed Name Signal ire Month Day Year <br /> ; ° 43710? <br /> Zed Transporter 2 PrintediTyped Name Signaiture Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue <br /> ❑Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> Sc 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> uu- Facility's Phone: <br /> W 18c.Signature ofAitemate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,odes for hazardous waste treatment disposal,and recycling systems) <br /> H132 <br /> 20.Designated Facility Owner or Operator Cert nft of receipt of hazardous materials covered by the manifest except as n led in Nein 18a <br /> Printedffyped Name Signalise Month Day Year <br /> EPAFam 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />