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1.Shippers US EPA ID No.(If AppYceble) ^^°^t No• 1 <br /> BILL-OF LADING/MANIFEST <br /> 3.9NppeYe Nemo and Mews Addy m W I 1-SON WAY TIRE <br /> 221 N WIL-SON WAY CA 95205--4505 <br /> STOCKTON <br /> 4.Shl a Phone P-09-t46-5-0281 <br /> 6.Transporter 1 Company Nemo e. US EPA ID NumbeA.Transporters Phone <br /> r <br /> 6. US EPA ID Number B.Transporters Phone <br /> 7.Transporlar 2 Cortlpeny Name <br /> Q.DeelpAeted F-aclily Name and Site Address 7401 <br /> 10. US EPA W NLP*w C.Facitlty's Phone <br /> SAFET'Y•-KL..EEN SYSTEMS INC. <br /> 17. ? COOPER CREEK R13LD T'XD077603371 940 483—Sc'Q)0 <br /> DE1VTON, TX 76208 <br /> 12. inem 13. 14. <br /> 11.Shipping his"and DescriptionTotal Unit <br /> No. TYPa . Ouan' wwd <br /> HMI - I <br /> EXEMPT SCRAP METAI. FOR RECYC3-E DF j t 5l7 FA <br /> (METAL. BRAKE SHAVINGS) <br /> b. <br /> S <br /> H - <br /> I c. <br /> P <br /> P <br /> E <br /> R d <br /> 15.Spedlal Handing Instmc Add loom Into n <br /> SK SH:)('�H r304077�'i'stQ 101DG]11A4:, <br /> ;=4 HR EP4ER&ENCY #1- 800-468--1760 (SAFFTY^-KI_EEN — CONTRACT #54138) <br /> SK AUTH7 D TO USE SUB91EO ]ENT I �1RR.(VR`:41079,4'4471, Fl16�11,82739, (35399 <br /> DOT'/PRFL A. 1.407H/1.`..)Q)27E, B., 0. D. <br /> A) C) D) <br /> 161x.US DOT HA2ARDOUS MATERIALS SHWPER'S CERTFICATION: -n'aauui/rawarramwmieaa m.mdMaw„.pa,ya..aaa.awse.a,Mavaws.sanma.w i.seba.m.r.�,w.v. <br /> Mania Day Year <br /> PrMed/Typed Name <br /> 16b.IbN4tEGULATED SHIPPER'S CERTIFICATION: I ow*e»materiels daabed aboro on Bae faun ars not sablect infederal mgulNbns forTranspataeai or Disposal. <br /> Mader Day Year <br /> prints /„yped Name I r <br /> \/[ I r <br /> T 17.Transporter 1 Acknowledgement of Recelpt of Materiels Moom Day veer <br /> A nted/Typad ame , Signature -� <br /> b <br /> O 19.Tmrmporter 2 Acknowledgement of Recaipi of Mstedals Signature <br /> Day rest <br /> R PdntedrTyped Nemo <br /> T <br /> E <br /> 19.Discrepancy indication Space <br /> F <br /> A <br /> C <br /> I <br /> L 20.Facility Owner Of Operates:Cerstiostion of receipt of metedWs catered by this form except as noted in Item 19. <br /> I <br /> T Signature Month Day yea <br /> y printed/Typed Name <br /> GENERATOR'S COPYFORM No.01-90291(1110f <br />