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tl <br />H <br />1 <br />P <br />P <br />E <br />R <br />BI L`L OF LADING/MANIFEST 1. Snippets US EPA ID No. (IFAppfimhle) Dowment No. 2 gaga 1 <br />_ of <br />3. Shlppera Name and Mailing AddressMr.NL 1 LI,JS TRUCK .. <br />3J.00 N Nd Ort Rd <br />A1TN1 R(II_Pil CORTf:'_ <br />4. snk <br />pper'SPhone{ Stockt: Tl [:H 1:ot:IS—r yti <br />5. Transporter 1 Comparry Name 6. US EPA ID Number <br />A. Transporters Phone <br />7. Tremporler 2 Corr�any Name S. Y U P I Number <br />B. Transporters Phone <br />D. Designated Facility Name and She Address 10. US EPA tO Number <br />7 i•' i" 1 <br />C. FacltiVe Phone <br />6011140 86TH <br />„3faGEiAhi�iV'rG� L:f� `a`��jc'c�, C:N7s(;'Iu�k'tu)�!4w17 <br />�,i6-:,'r'3Es-43i:3 <br />f t. Shipping Name and Descrip[bn <br />12. Conti <br />finers <br />13. <br />74. <br />NM__l <br />No. <br />Type <br />Total <br />- Ouardity <br />Unit <br />IYWol <br />a. <br />JN1'-10 HER080i_-73, fE-'W_H NOT NYt:f., 1).i1u <br />t <br />I. CAPACITY) TY) { L#N J VERSAL Wit=4t3T(D, 2. 1 , <br />� <br />lm <br />f � 5 <br />PitiNl'Jf25A1. <br />Wt�7E fVF1FiS0i_�? <br />[ <br />b. <br />a. <br />24 Hca EMERP NCY #1- ti11-44,8 -iTF,O (SPFFTY�-KLEE=N' <br />8K �'J09567e4 000704i" <br />3}i AL)THORI7FA) TO WrPIIN LICFWS'Cii .3�iz+F�(:17JE}dC lF1Fii2Lc#:i �i`_e NLLc.S.roli�SY <br />r)fJT/PRFL A, 7369417,'40701083 73. C;. D. <br />A) NOW W [:) [ij <br />-��U`f` <br />16a.USDOTHAZARDOUSMATERIALSSHIPPER'BCERTIFICATION: 7ft-0,-t°"fbl* '°"1tl�'+•. ram+be.e..enc.ara�c+ros.a,meaawypeye.rw,,,r,yro�e,- <br />P yped Name _ <br />_. ,I,.. �' • n � Li7a7Y Year <br />'I M NON4REGU TED SIIIPPER'S CERTIFICATION: i cer6ry 1de m�eMls desaked ebove'dn eds rutin ere not aub;era regvlaaons for Tmnspeleycn a lHaposal. <br />. Pdnledrryped Blame <br />Um"m Ray Vow <br />R17. Transporter 1 A&r wledgement of Recelpt of Materials <br />Ndm <br />P' Signature: <br />Osy Year <br />O 1$- TrampoAer 2 Acknumedgemaut or Receipt of Materials <br />ER PrhrtedtTypad Name Signature Nom <br />rby Yoar <br />19. Discrepancy Indication Space t <br />F <br />A <br />C <br />1 <br />20. Fepldy Owner or Operator. Ce(gfiwdcn of receipt of materials covered by this roan except as noted in Item 19. <br />T <br />Y P' 111 Name Signalum <br />slonlh Day dear <br />rl-.,k>11G1 r � <br />T/S/D/F COPY <br />RECEIVEL" <br />AuG,07Z015 <br />ENVIRONMENTAL <br />Page 11 <br />