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_L OF LADING/MANIFEST Shipper's US EPA ID No.(If Applicable) Document No. 2 Page 1 <br /> {., t, of <br /> Shipper's Name and Mailing Address °I <br /> 4.Shippers Phone( ) <br /> 5.Transporter 1 Company Name 6, US EPA ID Number A.Transporters Phone <br /> 7 Transporter 2 Company Name 8. US EPA ID Number B.Transporters Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number C.Facility's Phone <br /> 11.Shipping Name and Description 12.Canta,vars 13. 14. <br /> Total Unit <br /> HM No. Type Quantity Wt/Vol <br /> b. <br /> S <br /> H <br /> I C. <br /> P <br /> P <br /> E <br /> R J. <br /> 15.Special Handling Instruction and Additional Information <br /> - <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: Tmala m carry that above-named matetae are proppdy deterred.eescbbee.eackaseo.marked and labeled add are in Proper <br /> mnaden lar terra ronacmmin tomes ulatmne applicable nine oe ntmept of Trane me <br /> Printecirryped Name Month Day Year <br /> a• - <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on this form are not subject to federal regulations for Transportation or Disposal. <br /> Printed/Typed Name Month Day Year <br /> rT <br /> R 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> s A Pnntedrfyped Name Signature Month Day Year <br /> N <br /> la <br /> P <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> TPrinted/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> G F <br /> FA <br /> � I <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 /> wI <br /> oT <br /> �Y Printed/Typed Name Signature Month Day Yew <br /> EP 'k <br /> GENERATOR'S COPY FORM NO.01-90291 (11/09) <br />