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BILL OF LADING/MANIFEST 1.Shipper's US EPA ID No.(If Applicable) Document o. 2.Pagel <br /> ;,r to t7uiitl"+..1 dir i.i -:u t.�i c.-zi?Y.., of <br /> 3.Shippers Name and Mailing Address MC LAI`dE F QODn` <br /> 800 E=:AS1. PES :ADER0 DR <br /> TRACY CA 95304 NOV 10 2010 <br /> 4.Shippers Phone( i.'4)9 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.TrarENTAL HEALTH <br /> C11: :r"7- /.-d%.i 1-F.'hi ::WRTPMq- T f'- 1 7 Y PtAiAiX`N,f7r4.Gt 4`011M1T - <br /> 7.Transporter 2 Company Nam 8. US EPA ID Number B.Transporters Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number C.Facility's Phone <br /> r, RC:a ruM 1NC: <br /> 306 77 R.)hT1406b AVE: <br /> HAYWCIRD CA 94544 CAD98c:41, '.=19;. `,1V1)...42-9?-11i?9 <br /> 11.Shipping Name and Description 12.Con liters 13. 14. <br /> Total Unit <br /> HM No. Type Quantity vvwoi <br /> a. ONIVERSAL WASTE LAMPIS <br /> ',ILIJDRESCFNT LAMPS) =� CF <br /> b. <br /> S <br /> H <br /> 1 c. <br /> P <br /> P <br /> E <br /> RT- <br /> 15. <br /> d15.Special Handling Instruction and Additional Information <br /> SK SHIP# 202,346 354 3P 741 :1"7 <br /> 24 HR EMERGENCY #1-800-466-1760 (SAFETY—KLFEN 94138 <br /> A) NONE <br /> SK AUTHORIZED TO RETAIN LICENSED SUHSEULIENT CARRIERS AS NECESSARY <br /> DOT/PRFL A. 14815/150-R28 9: C. D. <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: Thia 1'm`amfy met he abaee-nomad matermm are prooeny dammed.dein,need.pacragee.marked and labeled am are in proper <br /> mndillon for baoo odium wcoaling th in applitni,le re mapone of Department of Transirodatlon. <br /> Pnntedrryped Name - 1111111, Month Day Year <br /> •• <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION:I certify the materials described above on this form are not cabled to federal regulations for Transportation or Disposal. <br /> •" Pri/n�tgd/Typed Name 57 Month Day Year a <br /> R17.Transporter 1 Acknowledgement of Receipt of Materials _ <br /> A PrinteolTyped Name Signature Month Day Year <br /> N <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R Pnnted/T ed Name Si nat m-l' <br /> T YP 9 Monts Day Year <br /> E <br /> L20.Fadility <br /> Indication Space <br /> r or Operator:Certification of receiptof materials covered by this form except as noted in Item 19. <br /> d Name Signature Month Day Year <br /> :at .11MMt <br /> GENERATORS COPY FORM NO.01-90291(11109) <br />