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Mill 3w <br /> 1.Shipper's US EPA 10 No.(If Applicable) Document No, 2 Page 1 <br /> BILL OF LADING/MANIFEST of <br /> 3.Shipper's Name and Mailing Address <br /> 4.Shippers Phone( ) <br /> S.Transporter 1 Company Name 6. US EPA ID Number A.Transporters Phone <br /> F.. m Yt '1:1' :IJi. "2'.J•^•tt(: E C•l' <br /> 7.Transporter 2 Company Name 8, US EPA ID Number B.Transporter's Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number C.Facility's Phone <br /> A E R C' COi4. 1N <br /> L06M HUNTW00P AVE, <br /> HAYWAR: CA ?4544 CAD9824118° <br /> 11.Shipping Name and Description 12.Contliners 13. 14. <br /> Total Unit <br /> HM No. Type Quantity WWol <br /> a. :ap •. lg i813:^EN�F-4�`PH •. BI1 E16 <br /> Iafl`2`'�tTC�T"C7Ea""Li�'P�""R'Ft�'tf'tr'�7={�U" <br /> CF r <br /> th <br /> S <br /> H <br /> I c. <br /> P <br /> P <br /> E <br /> R d. <br /> 15.Special Handling Instruction and Additional Information <br /> MFST R/0000000cJ(" 0. 0011- 00 <br /> EMERCENCY RESP 800-4b8- 1760( 24 E;R1 , IF UNDELIVERABLE kETURN To GENERATOR . <br /> ;;K CORP AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECES`,hP..)! . <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: 'This;,m eemy non rhe ebuvena,ned merendhi,ere W.Mily daesaed.deaonbed.gechaged.mereed and labeled end re in pmee, <br /> condid1w for lensonahon aoo,od.lo to the 6 inable,aulations of the De lent of Tonexineud., <br /> Printed/Typed Name Month Day Year <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on this form are not subject to lateral regulations for Transportation or Disposal. <br /> •' Printed/Typed Name Month Day Year <br /> in...101,11111,17.Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> A PrinteQ(ryped Name Signature _ Month Day Year <br /> 5 <br /> P <br /> O 18.ifransporter 2 Acknowledgement of Receipt of Materials <br /> R Printed/Typed Name Signa[uIe Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L 20.Facility Owner or Operator:Certification of receipt of materials covered by this form except as noted in Item 19. <br /> 1 <br /> T <br /> Y I PrinledfTyped Name Signature Month Day Year <br /> GPNPRaTnR-Q CnPY mann ntn amod rt vont <br />