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--^®VEOMITAL SERVICES �I�III�gIIIIIIII��II I� • <br /> SHIPPING 1.Generator IF Number 2.Page 1 of 3.Emergency Response Phone 4.Shipping Document Tracking Number <br /> DOCUMENT r _ - - - - e.7... -:. - -„ ZZ 00185513 <br /> 5.Generator's Name and Mailing Address Dimensions Site Address(it different than mailing address) <br /> SA.h4E <br /> Generator's Phone:20� 4_3-i <br /> 6. ransporter I Company Name <br /> .S.EPA ID Number <br /> VE0,UA.ESTECHtQ(C'ALS0f1;TIQPd3 RJ J D C - <br /> 7.Transporter 2 Company Name U.S.EPA 10 Number <br /> NIP Et'J`,IR: dWENTAL 9ERN ICES A T B <br /> 8.Designated Facility Name and Site Address - /A LILS.EPA ID Number <br /> 14P Ail AW nconoTAill <br /> Fal AsPhone. i i4 G:2 'q <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name.Hazard Class.ID Numbe 10.Containers 11 Total 12Unit <br /> Olantity Wt.Nol. <br /> HM and Fading Group(if ani 13.Codes <br /> No. Type <br /> -PdE I <br /> qa l u7 f- F I:i 1 Fj G f- <br /> z 2 Lu+ �E;•L.Fh, iAM1�IPS L F - - UPS.(' :NE <br /> D n a C F ilDii3U F <br /> p.J ;NE <br /> r f G CXJOSO <br /> 4. <br /> I <br /> 14.Special Handling InstNdkm3 andl Additional Information <br /> tr + � VESTS -1- 1)'✓Q926A'SLM11UC2, i'::'V:•rpgr3A. <br /> .,Lx�111.i4, 31 '0276 A c'LM' I q <br /> 15. GENERATOR SIOFFEROR S CERTIFICATION: 1 hereby declare that the contents of th s consignment are fully and accurately described above by the proper shipping name,and am classified,packaged. <br /> marked and Iahelecleararded.and are in all reswis in proper condition for transport -forcing to applicable international and national governmental regulations. <br /> Tato ale s n tNa Siff m on ay Year <br /> © Los <br /> 16 International Shipments <br /> ❑ <br /> _ Import to US Export from U.S. Port at entrylexlt: <br /> Transporter a nature for exports onI : Date leasing U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Shipment <br /> Transporter 1 Pnnled(Typed Name Signature pr' ay ear <br /> NF'td N'tis?G-IdE D _ <br /> Tj Transporter 2 Pdntedlfyped Name Signature on D.7 I ear <br /> F Q IZ <br /> } 18.Discrepancy <br /> 1Sa.Discrepancy Indication Space El Quantity ❑Type <br /> ❑Residue ❑Partial Relectan ❑Full Rejection <br /> Shipping Document Tracking Number. <br /> Z 186.Alternate Facll9y(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> Q <br /> LL EL sPhone: <br /> w1&.Sgnsure ofAltemam Facility(or Generator) <br /> f— Month Day Year <br /> z <br /> z <br /> N19.Report Management Method Codes(i.e.,codes for treatment.disposal,and necycling systems) <br /> m 1. 3. 4. <br /> �iyr �� r <br /> 1 28 Desgnated Facility Owneror Operator Codification of receipt of shipment except as noted in Item 18a <br /> Pdntedrryped Namem Monti Dayaly.- <br /> v E e3 e9 <br /> DESIGNATED FACILITYTO GENERATOR <br />