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BILL OF LADING/MANIFEST 1. Shippers US EPA ID No. (if Applicable) Document No. <br />2, page 1 <br />CAL000276412. 11504. <br />°F 1 <br />3, Shippers Name and Mailing AddressCn E 2 I III I r UC <br />3100 N Ad Art Rd <br />Attn: Ralph Cortez <br />Stockton CA 95815-8218 <br />4. Shippers Phone ( 80S 931-4888 <br />5. Transporter 1 Company Name 6. US EPA IO Number <br />A. Transporter's Phone <br />SAFETY—KLEEN SYSTEMS INC. . TXR000081.205. <br />972-265-2001 <br />7. Transporter 2 Company Name a. US EPA ID Number <br />B. Transporter's Phone <br />9. Designated Facility Name and Site Address Si 10. US EPA ID Number <br />C. Facility's Phone <br />CLEAN HARBORS SAN JOSE LLC <br />1081 BERRYESSA ROAD <br />SAN JOSE CA 95133 CAD059494310 <br />408-441-0962 <br />11. Shipping Name and Description <br />12. Cont <br />hers <br />13. <br />14. <br />Unit <br />HM <br />No. <br />Type <br />Quantity <br />a. <br />UN1950 AEROSOLSEACH NOT EXCEEDING <br />X <br />1 L CAbAC I TY) MN I VERSAL WASTE) , 2.1-, <br />DM <br />P <br />(UNIVERSAL WA§TE — AEROSOLS)1 <br />H <br />AUG 0 7 <br />2015 <br />C. <br />P <br />ENVIRONMEN <br />AL. <br />E <br />r:CA+TIJ R <br />T <br />Y <br />R <br />d. <br />15. Special Handling Instruction and Additional Information <br />SK SHIP# 216012550 <br />MC82499 <br />24 HR EMERGENCY #1-800-468-1760 (SAFETY—KLEEN) <br />SK AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY <br />DOT/PRFL A. 7369417/40701083 S. C. D. <br />A) NONE B) C) D) <br />-5Vl q <br />16a. u5 DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION' 'Thio Is to m dy that thesbove--d ateriel. are p d-9 l betl, pa s ageA, ma ed and labaletl and era In proper <br />• —Man fw trio. drttki a0mdrdln to," a imbl latioruo rimantaf 7m <br />Printed yped�rName � I <br />&Ae�- <br />Month /Day rear <br />V' J ti.7 r • <br />fA' <br />6b. NON-REGULATED SHIPPER'S CERTIFICATION: I cartiy the materials destxibad above on this form ar ubject to f <br />I regulations for Transportation or Disposal. <br />• - <br />PrinledlTyped Name <br />MN fh Day Year <br />T <br />R <br />17. Transporter 1 Acknowledgement or Receipt of Materials <br />A <br />Pri ecTryped Name S' <br />Month Day Year <br />5 <br />% <br />P <br />o <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />T <br />PrintedlTyped Name <br />Si natu re <br />9 <br />Month Day Year <br />E <br />R <br />19. DlscrepancyIndication Space <br />F <br />4 <br />I <br />L <br />20. Facility Owner or Operator: Certificatlon of receipt of materials covered by this form except as notedInItem 19. <br />T <br />Y <br />'nt d+Typed ame �r � Signature <br />1y <br />Month nay Year <br />800 -4658-1760 <br />(S40TY-KILEEN-CONTRACT <br />#94138) <br />ORIGINAL -RETIA TJ GENERATOR <br />FORM NO. 01-90291 (0411) <br />