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1. Shipper's US EPA ID No. (h Applicable) Documerd 2. Page 1 <br />BILL OFtLADING/MANIFEST of <br />3.31tippers *me and Mailing Addrewt, 1 t�1 •'�H <br />12 aasseserr Ave Ste 2 8D i 7 2N <br />MATECA EA 95337. <br />4. Shippers Phare ( 209—P23 -a775 <br />8. <br />5.. Transporter 1 Company Name US EPA IQ umber A. TrensPorter � F'ARTMENT <br />SAFETY-KLEEN SYSTEMS. INC.. TXRw@381e..S5 ,. 572-�65"a @0 <br />f, <br />Ti pmtsr2 ComPany Name 8. US EPA ID Number <br />8. Ymnsportses Phone <br />9. <br />Designated Facility Name and Sita Addrass : s� G�i7i8�J 1fl. US EPA ID NUmDCr <br />C. Faollip O Phone <br />SEAPORT REFININS & ENVIRONMENTAL, LLC <br />700 5EAPORT'BLVD. <br />REDWOOD CITY "CR 94063 GAL 000311135 <br />650-364-1024 <br />11. <br />shipping Name and Deeaipuon <br />jpers <br />13. <br />Total <br />% <br />Type <br />Quantity <br />wwol <br />HM <br />a <br />ONE NON RCRA.HAZARD?US WASTE -LIQUIDS <br />S <br />(OILY SLUDGE. WATERT MIA <br />b. <br />s <br />H <br />I <br />G <br />P <br />P <br />E <br />R <br />d <br />15: Special Hendling lostwdion and Addispnal Information S+K SHIP# 811821793 F•LIS175 <br />FIe#t.WasM--- <br />-� 1 -is "Bessemer <br />MANTECA CA 95337-6118 <br />24. HR EMERGENCY #1--800-468-1760 (SAFETY--LEEN) <br />SK AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY <br />DOT/PRFL A. 41369585/40447371 B. C. D- <br />A) 2 B) C) D) <br />"LM K bmA%mai the ebwB eeeae nat.dae 11:1 :1 eeecrmlpd peaagea, muses end yry,.0 an0 ueln p.ps <br />108. U9 DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: me nercn ai mma awwa i ' asmma t <br />Pfiitted/Typed Name MmD P9Y' Yev <br />18b.NON R@GULATEDSHIPPER's CERTIFICATION:to"t/the malenalsdee*md above on th'; rem+ are not aubl na for TM-Partaaen or Plap"I. <br />Day Year <br />Fri y NBrFa "i <br />1194b al 1.3 <br />1 . Tr a 1 Acknowledgement of RaCeipt of Materials <br />R <br />A <br />Antedrryped Name 8f re e Mcrrll+ pay Ye <br />- b <br />e <br />a <br />P <br />O <br />18. Trees 2 Acknowle <br />R <br />T <br />Printedffyped Name - Signature sMIMIi pry Year <br />E <br />R <br />19, Discrepancy Indlcation Spaee <br />F <br />A <br />C <br />L <br />I <br />2o. Fadfity Owner or Opereta: Certl5ce5on aF receipt o<matarials COVefed,b'y flus farm except as noted in Item 19. <br />T <br />Y <br />printsommffmme �-a <br />Signature r Monm nay Year <br />ORIGINAL -RETURN TO GENERATOR FORM NO. at -98291 (04/11 <br />