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1. Shippers US EPA ID No. (If Applicable) <br />BILL OF LADING/MANIFEST <br />3. Shippers Name and Mailing Address MCNE I LUS TRUCK <br />3100 N Ad Art Rd <br />Stockton <br />nt No. 2. Page 1 <br />71 1 of i <br />CA 95215-2218 <br />4. Shippers Phone ( 209-1931-42B2 <br />5, Transporter 1 Company Name 6. US EPA ID Number <br />7, Transporter 2 Company Name 8. US EPA ID Number <br />9. Designated Facility Name and Site Address 7221 10. US EPA ID Number <br />SAFETY—KLEEN SYSTEMS, INC. <br />6000 88TH STREET <br />SACRAMENTO CA 95828 CA0000084517 <br />11. Shipping Name and Description <br />HM <br />a. UN1950 AEROSOLS FLAMMABLE, 2.1 <br />K (UNIVEhSAL WASTES <br />■Q <br />s <br />H <br />I c. <br />P <br />P <br />E <br />Rr <br />A. Transporters Phone <br />97P-2( <br />B. Transporter's Phone <br />C. Facility's Phone <br />916-366-4913 <br />12. Cont iners 14 <br />Total Unit <br />No. Type Quantity WUVoi <br />! DM —1 C�i P <br />ENVIRON <br />I <br />15. Special Handling Instruction and Additional Information <br />5I'. <br />10007042 <br />1)ERG#2 �GENCY ##-8�-4681S67Fti TY -3 <br />24 HR EE(LEN <br />— CONTRACT #'x94136) <br />SK AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY <br />DOT/.PRFL A. 19038/12400 B. C. D- <br />A) NONE B) C) D) <br />16a.USDOTHAZARDOUSMATERIALSSHIPPER'SCERTIFICATION:'ThlslssoEnffijlnatmeawvenemaemaianasarePro�n�-�1tho�o •w_.r=--- - <br />wnd{eon Ser bens tlen aewrdl to thOa ilceblere elal of the De admenl or Trans orfatian. <br />Priniedffy ame .` ' Month Day Year <br />16 .NON-RECnULATED SHIPPER'S CERTIFICATIpN; t certify rhe materials described above on Ihls form are not subJect to lederal regulations fw Transportation or Disposal. <br />PrintedfTyped Name Month oay rear <br />R 17. Transporter 1 Acknowledgement or Kecelpt of malenals <br />A Pr dff�2yp Name Signature <br />N <br />v,�fa <br />P <br />O 18. Transporter 2 Acknowledgement of Receipt of Materials <br />R Printed/Typed Name Signature <br />T <br />E <br />R <br />19, Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />"L 20. Facility Owner or Operator: Certification of receipt of maierlafs covered by thls form except as noted In Item 19. <br />T <br />Y PrintedlTvoed Name„ Signature y <br />Month Day y ar <br />7• . i <br />Month Day year <br />Month Day year <br />0-/ 16,911--1 <br />FORM NO. 01-94291 (04111) <br />-jEBIGNATED FACTLITY COPY'' <br />