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1158174- 15540 <br /> HAZMAT BILL OF 1,Oderors ID Number 2.Page 1 of 3.Emergency Response Phone 4.Tacking Number <br /> LADINGRANIFEST CAT000610949 1 (801})326-1'c'^c1 1158174-15540 <br /> f1isNdMi h "ad2essbAN PEREZACY) Wv �r2400 WEST VALPICO ROAD—SITE 400 WEST <br /> VALPICO ROAD--SITE <br /> TRACY, CA 95376 TRACY CA 95376 <br /> Offerors Phone: (209)836-1971 GEN. 94495 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> TRIAD TRANSPORT, INCORPORATED I OKD981588791 <br /> 7.Transporter Company Name U.S.EPA ID Number <br /> S.DaEEsiggnate l Fact Name and Site Address U.S.EPA ID Number <br /> 54IEAS OREYIRDNMENTAL SERVICES LLC AZD081705402 <br /> COOLIDGE, AZ 85228 <br /> Facil y's Phone: (520)723-4167 <br /> 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12,Unit <br /> HM and Packing Group(6any)) No. —Type Quantity WLNol. <br /> X 1 UN3028 BATTERIES DRY, CONTAINING POTASSIUM HYDROXIDE ` r /n <br /> SOLID,8,PbI II,ERGM4 6 bCJ <br /> 2' NON—DOT UNIVERSAL WASTE—MERCURY CONTAINING LAMPS <br /> B. NON—DOT UNIVERSAL WASTE—MERCURY CONTAINING LAMPS ) J <br /> W <br /> 0 4' NON—DOT UNIVERSAL WASTE—MERCURY CONTAINING LAMPS <br /> s. <br /> 6. <br /> 7. <br /> 113.5ri5al lidlnir�Tnsa,�gdtii�i�pal ,tt�og 17 3.W17 0532378 4. W18 0.532371 <br /> [13519991 <br /> 14. OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described ov by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable internatio tonal go em ntal regulations. <br /> Offeror's PdntedRyped Na a Signature Month Day Year <br /> �t7 hCAI A iSO'�1 Z f Cll V <br /> 15.Transporter Acknowledgment of Receipt of Materials <br /> gTransporteri /f��pp{gg�.V�I—�ame /yy�/^ w on a`yyy� ear <br /> �r22a yl{O✓1 / � /� A-lii / I / <br /> Transporter Primed/Typed Name ign r on ay ear <br /> 1-6—5.7 <br /> 17.Designated Facility Owner or Operator:Cartlfication of receipt of hazardous Bill of Lading/Manifest covered by the manifest except as noted in item 16 <br /> Phrasal Name store Month Day Year <br /> 1I 6'p I OLt I Ill <br /> DESIGNATED FACILI TO OFFEROR <br />