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1 <br /> 1.Shipper's US EPA ID No.(If Applicable) Document No. p page 1 <br /> BILL OF LADING/MANIFEST Cf1LC1[zG12 ! I. f L5 I of <br /> 3.Shipper's Name and Mailing Address <br /> 2 ?a- pocY 'LAIdF <br /> 5TOr;KTnN CA 95206 <br /> -14.Shipper's Phone(' '3 "`)9;! -],83.Ei- <br /> 5.Transporter 1 Company Name - 6. US EPA ID Number A.Transporter's Phone <br /> AF "'TY •:LEEN ;YTEPIS INC TXI6000l}'W930 . 309 669-574(:' <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transporter's Phone <br /> 9.Designated Facility Name and Site Address 0,50702 10. US EPA ID Number C.Facility's Phone <br /> t r7LP G,R,Ellflrto, %Ll. IOC' <br /> t.')8 8 0 :9M 1111 Avg <br /> NEWARK CA14. <br /> ; .t',,..R �t;•fI <br /> 11.Shipping Name and Description 12.Cont finers Total Unit <br /> HM No. Type Quantity WW01 <br /> a. +laid- REG ILA'UD {„IQtlIL, N72s <br /> --VOT r (,.'G' rLATEC FViA'1'ERI A1- <br /> ;'ltc .-0.iL WATFR, rs`,UNIE" i <br /> b. <br /> i1 <br /> H r 59 <br /> 1 c. <br /> P <br /> P <br /> E <br /> R d. <br /> 15.Special Handling Instruction and Additional Information <br /> 41T'", I I;e'r`I't i(T r?AiS 14 <br /> IfES Soo- !h 17f,u1 'fi# fIR YF. CIIMFUXIT'EABLI PL21P1T Ir"I ' FNEPAI! <br /> ZEDI'1. TSE;`A10 f;C FW. F[` ;IJI', FQITF:N! <br /> CAP t,Fl! t g . NF'C E,,,AI <br /> h )O O Tic <br /> i6a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: T^IeF WceNy maulre.m.a-aamad mmedele am oraoady aee.med,e.aa,ieae.o.«ao.a.medadandleheledanda,aa Paasr <br /> wMXbn for trans odamn accoMin to mea IlceWe ulatlom of the Oe Nmem WT m, bn. <br /> Printed/Typed Name Month Day Year <br /> a• <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: Icedlfy the materials described above on lr:is form are not subject tofederal regulations for Transportation or Disposal. ' <br /> •- Month Day Yew •- <br /> Printed ed N me n ' <br /> ppy. �Lt� <br /> AA S/G `�/ .: <br /> T 17,Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> A Printed/Typed Name Signature Month Day Year <br /> N <br /> 3 <br /> P <br /> O 18.Transporter 2 Ackmow edgemeril of Recelp of Materials <br /> R Prinlecirryped Name Signature .Month Day year <br /> T <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C - <br /> I <br /> L 20.Facility Omer or Operator:Cedl6cauon of receipt of materials covered by this form except as noted in Item 19. <br /> I <br /> T -- <br /> Y Printecirryped Name Signature moon Day Year <br /> FORM NO.90291(11196) <br />