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MEMO <br />BILL OF LADING/MANIFEST 1. Shippers US EPA ID No. (If Applicable) I DMUMOM. 12_ Page 1 <br />1 <br />3. Shippers Name and Mailing Address <br />%��i ut �Li4y `JUs.c <br />TO Or <br />< L- f- (1 r <br />(,) � <br />{. ShipPers Phone( V '(,� �... ) -, 6 1 ,, �'. 1 I <br />S. Transporter 1 Company Name <br />6. <br />US EPA ID Number <br />A. Transporters Phone <br />7. Transporter 2 Company Name <br />8. <br />US EPA ID Number <br />8. Transporters Phone <br />9. Designated Facility Name and She Address <br />050702 10. <br />US EPA ID Number <br />C. Facility's Phone <br />1',,REEN OIL INC <br />at>80 SMITH AVE <br />NEWARK CA <br />94560 <br />CAD9808874.18 <br />510 795-4400 <br />11. Shipping Name and Description <br />12. Cont <br />finers <br />13. <br />14. <br />Total <br />Unit <br />HM <br />No. <br />Type <br />Quantity <br />WtNc <br />a <br />+ JE'SI,LtiTED LIQUID <br />l <br />P . 3 L U DG E) <br />_'}. U. 0 <br />b. <br />S <br />H <br />I c. <br />P <br />P <br />E <br />R <br />ME <br />115. Special Handling Instruction and Additional Information <br />MFST R/T#105715062 0-000-00 <br />C IIERGENCY RESF 800- 468-1'760( 24 HR). IF UNDELIVERABLE RETURN TO GENERATOR. <br />;K CORP AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSJrRY. <br />SKDOT# A: 3299 B: C: D: <br />16a. US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: <br />Printed/Typed Name <br />16b. NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materia <br />Ponted(ryped Name <br />T 17. Transporter 1 Acknowledgement of Receipt of Materials <br />above on this forth are not subject to federal <br />Month Day Year <br />.1.1. <br />or Disposal. <br />Month Day Year <br />R <br />A Printed?yped Name Signature Month Day year <br />N �` <br />a O <br />P <br />0 18. Transporter Acknowledgement of Receipt of Materials <br />R <br />ature Mon <br />Pdnted(Typed Name Signro Day Year <br />E 11{ <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />L I20. Facility Owner or Operator. Certification of receipt of materials covered by this form except as noted in Item 19. <br />1 <br />Y Printedrryped Name Signature Monro Day Year <br />A <br />