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-. btiRu' 'm _ ,� 'tt.°- -'i.�w= `"':.rte'" •r s'.� <br /> _. •Yrl�� _...�-�........_+. --Y- b. <br /> VEOLIA <br /> ENVIRONMENTAL. SERVICES <br /> 2.Page 1 of 3.Fanergency Response Phone 4.Shipping Docume�{T ekl m <br /> :S:HIPP1NNG t•Generator 11 Number f 669018 <br /> OCUMENT z 7--.� V V J. <br /> 5.Generato s Marne and Maf ing ACiir 5s� _ .. Gene atot3 SI Addf'ess llf d fterent than Waite g address) <br /> rA cg62W <br /> Generator's Phone:^•1] �:3't_h'+, U.S.EPA ID Number <br /> &Transporter 1 ompany Name <br /> r <br /> ;#:-1-r1 r .G r i& f aw-is y i€^..r� IP.S.EPA ID Number <br /> 7.Transporter 2 Company Name H <br /> U.S.£PA ID Number <br /> 8.Designated Facility Name and Sita Address <br /> F 3rh `(E0"sC,11CAL ,)LL#'tIf!NS, <br /> 1125 kIEN SLE— SI—REET <br /> Facility s Phone: I!W! 7 r 22 <br /> 'r`:ICNFt1C.d'1Cr.°.•� �si�t3.1 �� "° <br /> C©ni ciao <br /> ga 9b.FJ:S.DDT Descnptlon(including Proper SNAping Norms,Hazard Class,to Number, iu. 11.Total 12.Unit 13.Codes <br /> No. TYpe Quantity Nt Nodl. <br /> HMI and Packslg.Group(if any)) <br /> tY v 11 i^,!?4ilfl•�;>ti-f�f�l��i lj'�1,.,ft��",r1i-` 1 I :i.f 1 NONE <br /> ;;1�..; <br /> T+l3i;EFS tL W4 <br /> w ;. ) [s(:'y -S EA-1 <br /> i. l <br /> 4 <br /> 14.Special Handia+g Instructions and Additional intormat on _ 7i <br /> ER'-;:rmOt C.intfSmted by VESTS + 'J)�E�Ca:'I;&tl�`£�Pr�7�3ti rte:�Lk�l i k��€�us <br /> SUA 11411 <br /> 5. GENERATOR SIQFFEROR 5 CERTIFICATION: I hereby declare that the contents of this consignnrant are fully and accurately da Otted above by the propel'shipping reamer and are classified,packaged, <br /> maned and Iabeledlplaaarded,and are in all respects in proper ccndidon for transport accarding to applicable inlematfonai and national governmental regulations. <br /> Month ay Year <br /> Gs, rotor's eror's Printf yped Namgnawe <br /> 1 Inte na6oral hipmenfs Impon to U.S. Expoit from Pect of an !!exit <br /> r Data leavi <br /> Transporter signature for experts on <br /> 17.TransporterAckno0scigment of Receipt of Shipment Signature nl ay Year <br /> Transporter 1 Pdnle!Typed Name <br /> a .lEfit:MY.I,UCK ionatwe Month ay Year <br /> Transporter2 Printedfryped Name <br /> rK <br /> h <br /> 1a.Oisrrapanq �1 <br /> 18a.Discrepancy Indication Space ® Quantity ❑Type ❑Residue ©Partial Rewfidn .J Ful Rejection <br /> Shio document Tracking Number. <br /> U.S.EPA ID Number <br /> 18b.Alternate Facility(or Generator) <br /> U <br /> Facfl 's Phone: Wnth Day Year <br /> u, <br /> l sc.Slgneture of Alternate Facry{nr Generator) <br /> a <br /> Z <br /> 19.Repon Manageme+d Method Codes(l.e.,codes for Ireatmenk d sposal,and recycling systems} <br /> w 2. 3. p <br /> 20.Designated Far Gty&tmneror Operalbr:Certi icalwn of receiptoishipment except as noted In Item I U Sgnatwe ti n:n lay Year <br /> Printed!yped Name <br />