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r <br />1. Shipper's US EPA ID No. (H Applicable) Document N0' 2. Page 1 <br />BILL OF LADING/MANIFEST_ <br />a Shipper`s Name and Melling Address MCT'! e i l Us Trurla <br />3100 N Ad Art Rd <br />Attn, Ralph Curter_ CA 9S2i5-:218 <br />St ncEtt an <br />a. Shipper S Phone S 201-:4-931-4282 <br />5. Transporter 1 company Name 6, US EPA lD Number AZ m <br />n <br />- I= r - - -- <br />7. Transporter 2 Company Name s. US EPA ID Number Bone9. Designated FadRy Name and Site Address 5110. US EPA ID Number CCLEAN HAR13❑RS SAN JOSE, LLC <br />1021 BERRYESSA Ri]AB - 4 11-0562SAN .TORE CA 55133 GADO139 494310klers ,�.i. Shipp, g Name and Description TOWIType OVarrtily <br />HM <br />e_ UN1950 ACROSRLS (EACH NOT EXCEEDING 041 100 <br />X 1 L CA�ACITY) (bNIVERSAL WASTE), 2.1, DM <br />(UNIVERSAL WAW( - AEROSOLS) <br />IN <br />Har4ing Instruction and Additional lnformallan aC iTy� <br />5K 51iIF3#k 213719433. MG22 r r99 <br />24 HR EMERGENCY #1-800-468-1760 (SAFE=TY-KLEEN) <br />SK AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY <br />c <br />D❑T/PRFL A. 7369417/40701083 8, C. D. <br />A) NONE B) C) D) <br />10a. US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: 'rn.emw:mrrM<� •m+e-.+.+am�rn.a.nam� ^ + •e.cwotl. �a •d�lnnorors <br />cmtaon rat'. Gxf .ccaE h ev r>, TTmwn'M <br />Moth pay Year <br />P�.?ypod Name -7 I <br />16b.NON•Rc.OU1.ATED SHIPPER'S CERTIFICATION: ibertfy rhe materiels desalbed above m* -is Pom+ we not fed mfedarai rWaWm Ov r"neyertatlen w olst+mal. <br />.. Monty pay Yaw <br />Printadlryped Name <br />T 17. Transporter 1 AdricyMedgemenl of Receipt of Materials <br />R Signature <br />A Printed yped Name <br />5 n� <br />P <br />o 18. Transporter 2&kncMedgCmeiA Oi Recetpl Cf Materials <br />A PrintedrTyped Name Sk}nature <br />T <br />E <br />19, Dtscrapancy 1ndicaOon Space <br />F <br />A <br />C <br />I. <br />L 20. Facnity Orwnef or OParatar. C0rdflWiOn of recaipi of materials covered by this farm oapt as noted In Item 19. <br />3 <br />T Sgn re <br />. Y Prinl Na <br />ORIGINAL -RETURN TO GENERATOR <br />Page 31 <br />n <br />Month 'Dy Year <br />7 zy <br />MonlM1 peY <br />ye -5"I <br />VE1,- <br />2015 <br />IENTAI. <br />QT4AChrr <br />FORM N0.01 -90291(04t' I) <br />A <br />