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��...iry�il'n <br />Pep <br />'c�34ya_PaS,-"irc. <br />5> <br />_`"' �i`§,u <br />h n ry <br />.. s., ; o. .t P, ' <br />BILL OF LADING/MANIFEST '°' <br />j�L • 7 .. <br />Pep <br />3. Shipper's Name and Mailing dress <br />C3A./C I I (I <br />h n ry <br />�► �, zti <br />.> ���� <br />ENVIRONMEN <br />hippel's Phone ( }v2ni <br />5. Transporter 1 Company Name 5;== 6. US EPA ID Number <br />A. Transporte, 5 PhciiiicA1 rW ri QT41pwr <br />' <br />, <br />7. Tansporter 2 C mpanyyNNa»me 8. US EPA 117 Number <br />B. Transporter's Phone <br />9. Designated Facility Name and Site Addre s '7401 US EPA ID Number <br />C. Facilitys Phone <br />SA ETY—KI,.EEN SYSTEMS. INC. <br />1722 COOPER GREEK ROAD <br />DENTON, TX 76203 T X D077603371 <br />00 <br />940--483--5200 <br />1.l <br />11, Shipping Name and Description <br />12. Coi <br />Iners <br />Tota <br />Unit <br />j, <br />HM <br />No. <br />Type <br />Quantity <br />Wt/Vol <br />t <br />a. <br />Edi3Dl.EN LAST CONTAIN'ED A107�r�cffyt{�t <br />N <br />� (Z>P <br />� <br />I <br />f f 11 <br />r. <br />� <br />b. �1U }L(� [j 1. Ca Ti�f <br />GGr� C4nf��14 c.� }� A� <br />P <br />c <br />T <br />P., <br />,E <br />J. <br />1.. <br />Y <br />t <br />Ll <br />�LL t <br />T. <br />- <br />15. Special Handling Instruction and Additional Information <br />8 -'. , 1'[Y <br />SK Sk Z ll?<:t—T-ArE- <br />{# <br />..! <br />�4 HR .EIti11=RGENCY #1--800-468-1.760 dS<LEEN --- <br />CONTRACT #94139) <br />SK. A11TW D ' T9 . USE SUBSEQUENT CARRIERS: 410 78g at' :1471. <br />g 811581 y 82739, 80399 <br />� <br />Q <br />I?TlCFdI L.#a 3!clf�1:543� C. Ua Io�-or�`� <br />O) . nLlT a, 8 i B) -.: C) 7) o (/.Y,$' j ..(- <br />f . <br />76a. US OOT 1iAZARDOUS MATERIALS SHIPPER'S ERTIFICATION: This is to can ry that me eho�e-named m aadaie a e pn p■ y c ass rretl, descrlbea, pac ap■d, marxed and labeled end aro In proper <br />mntlll3an for Trans rtatian accortlln [o tha a cable r kailons of the De armentof Trane rlatlon. f <br />1 <br />rinte d Nane y� Ma1nih Day Year <br />>r <br />/,,��'/�. <br />/ <br />` <br />i <br />1 b. ON -REGULATED SHIPPER'S CERTIFICATION: I certify the materials desrrlbed above on.this torn are nor sabjecf to tederaf regulations for Transport@tion or Disposal, <br />PrintedlTyped NameMonth <br />Day Year <br />•� <br />',•.. <br />TR <br />17, Transporter 1 Acknowledgement pf Receipt of Materials <br />A'- <br />Pd dfTyped Nama Signature <br />,.` `r Month Day Yaar <br />o: <br />18. Transporter 2 Acknowledgement of Re eipt of Materials <br />Fi•' <br />i" <br />T <br />riniedlT ped Name Sign ure <br />.. Month Day Year <br />j,. <br />1-9. Discrepancy Indication Space <br />,. <br />1 % ; <br />IF <br />j <br />1' <br />Ce <br /># <br />I.- <br />.'. 20. Facility Owner or Operator. Certification of receipt of materials covered by this form except as nosed in Item 19. <br />Y Prinie Sig a rf <br />44 ) <br />- ) <br />Mont h Da .. %Ye <br />�13i <br />apeName <br />— <br />(f 4 <br />I L <br />(L <br />f <br />rTER#1 <br />FORM NO, Di -90291 {04!11} <br />