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BILL OF LADING/MANIFEST -- 1. sn ppara us EPA ID No. (rc App cave) nt IJo p 1 <br />3. Shippers Name and Maiang Address W ey a rrh a u s e r <br />2700 S California St <br />STOCKTON CA 95206-0000 <br />4. Shippers Phono ( 2097-373-82^56 <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />A. Transporters Phone <br />__ SaEFTY—KIEEN r INC T <br />7. Transporter 2 Company Name - <br />8 US EPA ID Number B. Transporters Phone <br />CLEAN HARBORS ENVIRONMENTAL S RVICES INCMAD039322 50 <br />781-792-5o <br />CLEAN HARBORS SAN JOSE - "- <br />1021 BERRYESSA ROAD <br />SAN JOSE CA 95133 1 CAD 059494310 <br />408-441-0962 <br />11. Shipping Name and Description <br />HM <br />12. Con finers 13. 14. <br />TotalUnit <br />No. Type auanfity wtNOI <br />X 1 <br />DM 1 <br />b' UN3028, Batteries, dry, containing <br />X---putassiUw-IT T-exl� solYa. ME, ,__ f; <br />S storage, 8, (UNIVERSAL_ WASTE) DF p <br />H <br />I C. <br />P <br />P <br />RC ---- - - ------ -- --- <br />15. Special Handling Instruction and Additional Irrtormatiorl <br />I)ERG#126.2)ERG#154• SK SHIP# 222360754 WE25333 <br />24 HR EME�GENCY #I -A00-468-1760 (SK / TFI) <br />AUTH AS "AGENT -FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSA <br />DOT/PRFL A. 7582382/958344 B. 77224012/958375 C. D. <br />A) NONE B) NONE C) D) <br />16a. US DOT HAZARDOUS MATERIALS SHIPPERS CERTIFICATION: <br />abiMl art thle I.- are not s.bjo to federal regulallons <br />ii 17. Trans er 1 krowledgeni of eipt Materials <br />A <br />N ��ACIVo <br />Na Signa <br />s _ <br />P <br />O 18. Trans er Acknowledgement of Receipt of Materials <br />R <br />T Name <br />E SI n Ure <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />1 <br />L 20. Facility Owner «Operator: Certification of receipt of materials Covered by tMs form except as noted in Item 19. <br />T <br />Y I Prin(ed/Typed Name .r"') f A Signature <br />ORIGINAL -RETURN TO GENERATOR <br />:poaal. <br />afw,m Day VOYr <br />Mwah Day Yser <br />(5-T 17V 7 <br />Mw,th Day Veer <br />FORM NO. 01-90291 (03,2015) <br />