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BILL OF LADING/MANIFEST SrdNEW 14Aers9EPA IDNo.(if Applicable) Document No. 2Pae1 4 <br /> C L7. 9.83E 64}5}1. ori <br /> 3.Shipper's Name and Mailing Address 1905 N MACARTHUR <br /> TRX7Y CA 95376-2833 <br /> 4.Shipper's Phone(209 8�2-5200 <br /> S.Transporter 1 Company Name 6. US EPA ID Number A.Transporters Phone <br /> SAFETY-KLEEN SYSTEMS, INC I SCR 00.:0075130 . 800 669-5740 <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Trarypprter's NNW-4913 <br /> 9.Desi nated Facilit�Name and Site Address 000618 10, - US EPA ID Number C.Facility's Phone <br /> SAF�"7 KLEEN SYSTEMS INC. <br /> 1722 COOPER CREEK ROAD <br /> DENTON, TX 76208 TXD 077603371 940 483-5200 <br /> 11.Shipping Name and Description 12.Conti iners 13. 14, <br /> Total Unit <br /> F—HM-1 No. Type Ouentity WWoI <br /> a. RESIDUE. LAST CONTAINED 7 ' ,t.. ! ew rvelt <br /> ( USE TX CODE OUTS3081 OR XAX DM <br /> S <br /> /1)S 7?! /CC`( CUT c 'C>t"Y Ci�p `�h'} Y `�' '►� t• 2 <br /> I c. <br /> P <br /> P <br /> E <br /> R d. <br /> 15.Spacial Handling Instruction and Additional Information kk <br /> EMERGENCY RESP 800-468-1760( 24 HR ).. Sr�UNDELIVERABLE5RETqURN TO GENERATOR <br /> SK CORP AUTH D TO USE SUBSEQUENT CARRIERS: 81300, 40355, 41015, 40582, 84815 <br /> SKDOT# A: 1617 8: (07 C: D: <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: The is to canny that the above named draudals are pmnedy eaaenled,daealbm.pssaxed.marred and labeled and are in groom <br /> common for indesgeitatigh acwmm mIn-a reuer Malan.of Ne Derearinders MTranspiration, <br /> Printed/Typed Name Mflmm Month Day Year <br /> R.R. <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on this forth ere not subject to federal regulations for Transportation or Disposal. <br /> Printed/Typed Name r in o v ar <br /> • T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> A Printselped,-Name ♦ ^� Signature Manrn Da r <br /> a 'N �, f i f •. _. <br /> P <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials — -- <br /> R Printed/Typed Name Signature Monln Day rear <br /> T <br /> E <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 Printed/Typed Name Signature Month Day Year <br /> Wn <br /> :.r .r .. <br /> GENERATOR'S COPY FORM NO.90291 (11/96) <br />