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BILL OF LADING/MANIFEST g1.Shipper's US EPA ID No,(If Applicable) Qocument No. 2.Page 1 <br /> � � ��.- <br /> 3.Shiph�s game and Maiiing Address of <br /> 4Cu LJ VHL,k� G� KD <br /> TRACY <br /> 4.Shipper's Phone( } 1 <br /> 5.Transporter 1 Company Name B. US EPA ID Number A.Transporter's Phone <br /> INC <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transporters Phone <br /> 9.Designated Facility Name and Site Address 0 51)7[y 2 10. US EPA ID Number C.Facility's Phone <br /> t'.i S 1''11 i t-' Y . <br /> NF!,!APV CA 94560 7,.; <br /> 11.Shipping Name and Description 12.Containers 1 13 14. <br /> HM <br /> Total Unit <br /> No. Type Quantity WtlVol <br /> a' <br /> NON—RE(' <br /> ON—RE( ULATELY LIQUID, NOT <br /> _,1�DQT PEGULATED MATERIAL <br /> «P,f, _t,YL, MATER. SLUDGE ) <br /> b. <br /> S <br /> H <br /> I C. <br /> P <br /> P <br /> E <br /> R d <br /> 15.Special Handling Instruction and Additional Information <br /> EMERGENCY RESP 800-468-1760( 24 RR ) 1tE tiJ` k/T#109305842 0000=- 3701-02 <br /> K CORP AMTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY <br /> SKDOT# A: 3299 C' l : <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION- 'This is to comfy that the above-named materials are properly classified,described.packaged.marked and labeled and are in proper <br /> Printed/Typed Name <br /> Condit-lar trams mrtabon aunrdin g[.the licabla+e Mations of the De anmant of Trans oration. <br /> Month Day Year <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on this form are not subject to federal r ulation Transportation or Disposal. <br /> rin#e yped Name <br /> r _ Month Day Yea <br /> T 17.Transporter 1 Acknowledgement of cei of Materials l <br /> R <br /> Ar_intedlTyped Name Si tura <br /> N Month Day Ye <br /> S " b , TU, x C <br /> P <br /> © ICTrans0ther 2 Acknowledgement of Re cei of Materials <br /> R if , <br /> Printed/Typed Name <br /> Signature <br /> E Month Day Year <br /> 19.Discrepancy E Indication Space <br /> F <br /> C Hlql <br /> I ' <br /> L 20.Facility Owner or Operator:Certification of receipt of materials covered by this form except as noted in Item 19. <br /> f <br /> Printed/Typed Name l Signator Month Day Year <br /> r <br /> ORIGINAL-RETURN TO GENERATOR FORM NO.90291(11196) <br />