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(I-1=`KWPA^ir)P11 rl.r)pv FORM NO. 01-90291 (0312015) <br />BILL OF LADING/MANIFEST 1. Shipper's US EPA ID No. (If Applicable) DOC UmentNo' 2. Page 1 <br />, of <br />3. Shipper's Name and Mailing Address °' s ''� '• '" <br />°Yi ` <br />3 r,r°ria c� <br />, <br />}��y3�[Cgy y (y <br />WN CA <br />4. Shippers Phone( �k' 1) _�...' <br />5. Transporter�1 Company Nta^me 6, US EPA ID Number <br />A. Transpodees Phone <br />e � e d� <br />S 5 i """ lk..b�_s" N YZ1,1, ! T. F9: NIC -fie k .Y ,. a&._ <br />,.X� a.. <br />7. Transporter 2 ComRaq N 8. US EPA ID Number <br />B. Transportees Pham . <br />9. Designated Facility Name and Site Address"' ;' 10. US EPA ID Number <br />C. Facility's Phone <br />i a?ii-AN HPR114WM4* 40w'3f::. <br />`)N YO!,f'- C <br />11. Shipping Name and Description <br />12. Cont.iners <br />13.14. <br />Total <br />Unit <br />NM <br />No. <br />Type <br />Ouantity <br />WWoi <br />a. <br />7 x �i <br />UN 6y"a���,�s» / 8 •� ¢A# 1 i IF P�syi,.r'j i �pK Y t i si + t "I .I.. Y�N6 <br />�„'S{ "., <br />i <br />,'� <br />'. <br />t £4! #.��•7 Y�'it/Y'[6d /r b. wJi� i✓`o) _iw. i�`.a t <br />i.r+... <br />P <br />WOV1E:, A, `_JNisVFRIS L Wi I <br />b. <br />H <br />1 <br />c. <br />P <br />P <br />E <br />R <br />d <br />Instruction and Additional Information � <br />S$gpeccjippal t <br />�+Y3 .: ri3d*"Fi° ,..k. `�„ „y�� A«a-�ti.�a.7 .':._� <br />y15. jHandling <br />i � i.•°rii�9T ��.-�^ � <br />A) # ONIC <br />168. US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: 'Th, i. to cenify mat the aor ve namod materials are propedyclaaeibed, desenbed, packaged. mariad and tabeW and are m proper <br />['nrMeUn ter flans Ia1-accordlnoIn the a fl -We rwiustions of it. [11eE~tf Tran. Nation. <br />Printed/Typed Name•' <br />r <br />hdonUr <br />pay Year <br />as V`r <br />16b. NON-REGULATED SHIPPER'S CERTIFICATION: t certify the materials described above on this form are not subject to federal mutations for Transportation or Disposal. <br />• <br />Printed/TypedName <br />as <br />Month <br />Day Year •' <br />T <br />R <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />A <br />.Afirtt@dr'Tryped N m@ <br />SIQRat t <br />Month <br />Day Year <br />P <br />O <br />18. Transporter 2 Acknowledgement of Rec&pt of Materials <br />TPrintedrryped <br />Name <br />Signature <br />Month <br />Day Year <br />E <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />1 <br />U <br />1 <br />20. Facility Owner or Operator: Certification of receipt of materials covered by this form except as noted in Item 19. <br />T <br />Y <br />PrintedrTyped Name <br />Signature <br />Monter <br />Day Year <br />(I-1=`KWPA^ir)P11 rl.r)pv FORM NO. 01-90291 (0312015) <br />