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Shipper's US EPA ID No.(If Applicable) Document No. 2.Page 1 <br /> BILL OF LADING/MANIFEST <br /> Of 1 24567 <br /> lk 3.Shipper's Name and Mailing Address DEPUY ORTHOTEL H <br /> 1905 N MA-:ARTHUR <br /> TRACY CA 95376-2833 <br /> 4.Shipper's Phone(204 802-5200 <br /> S.Transporter 1 Company Name 6. US EPA ID Number A.Transporter's Phone <br /> n.. _ bic r i r <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transporters Phone <br /> SAFETY-KLEEN ( TG !, INC. SCR 0000.14541 916 3 a 6- 4913 <br /> 9.Designated Facility Name and Site Address 000t,16 10. US EPA ID Number C.Facility's Phone <br /> SAFETY-KLEEN SYSTEMS INC. <br /> 1722 COOPER CREEK ROhD <br /> DENTON, TX 76208 'PSL? 07'7603371 940 483- 52UO <br /> 11.Shipping Name and Description 12.Con iners 13. 14. <br /> Total Unit <br /> HM No. Type Quantity wt(vol <br /> a. AV, IDUE: LAST CONTAINED ": : <br /> ( USE TX CODE OUTS 308! OR ;CXXX 3081 ) �'• t s ,1 � "�� <br /> b. <br /> S <br /> H <br /> 1 c. <br /> P <br /> P <br /> E <br /> R d <br /> j I <br /> 15.Special Handling.Instruction and Additional Information <br /> MF'ST R/ 049720091 0000- 3'71S-52 <br /> EMERGENCY RESP 800-468-1'760( 24 HR ; . IF' UNDFLUIrRABLE RETURN TO GENERATOR, <br /> SK CORP AUTH 'D TO USE SUBSE' IJENT CARRIFRN . S13f;i'), 40355, 41015, 40582, 8�l81S <br /> SHDi)r# A: 161`! B: C: D: <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: .m�'h r°runny vial m°asorenam.e m°mases aR ar�M°Iewwe.aeecrmm.oecws�e,me�ee.rw mselm.na Bran poper <br /> pmEiuon lar bens natmn ecwraln to mea ucebb W*nlM rM eMonlor Tre ftwn. <br /> Prtn[ed/Typed Name Month Day year <br /> ra <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I Cerny the materislsdeWnhed above on this loan.,,not subject to federal regulators tw Trensponation or Disposal. <br /> •- Pfinted7yped Name hbnm Day Ypar <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materiels <br /> R — <br /> A Printed/Type(1.Name j f Signature - Nonrn Day Year <br /> N � � ,4� ,�'� <br /> S <br /> P <br /> O 16.Transporter 2 Acknowledgement of Receipt of Materials <br /> TPrintedfryped Name Signature Month Day Year <br /> E <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> L 20.Facility Owner or Operator:Certification of receipt of materials covered by this form except as noted in Item 19. <br /> I <br /> T <br /> Y Printed/Typed Name Signature Momh Day veer <br /> :tt ' <br /> GENERATOR'S COPY -------- <br /> - <br />