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Q VEoua III��IAIIIIII�IIIIIIIII <br /> ENVIRONMENTAL SERVICES <br /> SHIPPING 1.Genemlor ID Number 2.Page 1 of 3.Emergency Response Phone 4.Shipping occurt T®ckiaB yumper�5 3 <br /> DOCUMENT 0 ZZ 0 2 5 8 <br /> 5. enamtors Name a idling Address pp Cp C uerewasors e cess rent an ma@ng address) <br /> 4545�AN�AS LANE DBA INDUSTRIES, <br /> LLLICS.INC. <br /> STOCKTON,CA 95208 4545 QUANTAS LN. <br /> Generators Phone: 209 493.8014 STOCKTON,CA <br /> 6.Transporter 1 Company azne .S.EPA ID Number <br /> VEOLIA ES TECHNICAL SOLUTIONS N J D 0 8 0 8 3 1 3 8 9 <br /> 7,Trensporler 2 Company Name L 0 7 2015 U.S.EPA ID Number <br /> 8.Designated Facifty Name aid Site Address VEOLIAESTECHNICALSOW71ONS, Us.EPA ID Number <br /> L.L.C. <br /> 1125 HENSLEY STREET ENVIRONMENTA <br /> Faci sPhone: EOG 243-2382 RICHMOND, CA 94801 1 C A T G 8 0 0 1 4 0 7 9 <br /> ger 96.U.S.DOT Description(including Proper Shipping Name,Haunt Class,ID Number, 10.Containers 11,Total 12.Unit 13.Codes <br /> HM AM Packing Group(d any)) No. Type Ouandty NM.AU. <br /> oe X 1. UN2800,BATTERIES,WET,NON-SPILLABLE,ELECTRIC NONE <br /> STORAGE,9A)UNIVERSAL WASTE <br /> 1 D F 88 P <br /> X z UN3090, LITHIUM AATTERV, 9,11 UNIVERSAL WASTE NONE <br /> 1 D F 40 P <br /> 3, FLUORESCENT LAMPS,USED. FOR RECYCLING UNIVERSAL NONE <br /> WASTE 4 C F 8 0 F <br /> 4 <br /> 14.Special Handling Instructions and Addhional Information <br /> ER Service Contracted by VESTS -I- 11 ERG:154 W 952788 ASt.M 183813 2)ERG:138 <br /> W 12794 A:SLM 111412 3)W12926 A SLM 110098 108 LAMPS TOTAL <br /> A&ruAt wet&44Y ' 0 B5 S <br /> 15. GENERATOR SIOFFEROR S CERTIFICATION: 1 hereby declare that the contents of this consignment am fully and accurately described above by the proper shipping name,and are cassifiad,packaged, <br /> marked and labeledlplacarded,and am in all respects in proper condition for transport according to applicable international and nallonal governmental regulations. <br /> emnam s r s and yped Name Signakim, Month Day Year <br /> 16A a�c u <br /> 16.Intemational Shipmems <br /> ❑Importto u's El Export from U.S. Pori of entylexN <br /> Transporter s' nature for exports only): Date learring U.S.- <br /> 17.TmnspoderAdmoMedgmant of Raceipt of Shiprment <br /> mnsponerl PrintedMIsral Name gru re ay Year <br /> gj CcM <br /> Transporter 2 PrintedfFyped Name Signature Atlanta Lmy Year <br /> r <br /> ♦ 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity El Type ❑Residue Portal Rejection Full Rejection <br /> Shipping Document Tracking Number <br /> 18b,Alternate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> a <br /> LL Facil' s Phone: <br /> 18c.SigneNre MAltemate Facility(or Generator) Monty Day Yew <br /> a <br /> z <br /> 19.Report Management McNM Codes(i.e.,codes for treatment,disposal,and recycling systems) <br /> 20.Designated Facial,Owner or Opemtor Ceffe;ation of receipt of shipment except as noted in Item 18a <br /> th <br /> rind 4V� nl D �� <br /> .-Ll' DESIGNATED FACILITYTO GENERATOR <br />