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1.Shippers US EPA ID No.(If Applicable) 2.Page 1 <br /> BILL OF LADING/MANIFEST C r of <br /> 0! <br /> 3.Shippers Name and Mailing Address 01 at­l H/S, lelt).�j55 <br /> 2650 N Mac arthur Dr <br /> TRACY CA 95376-2000 <br /> 4.Shipper's Phone( <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporter's Phone <br /> —\/STEMS INC -TXR0Q1C-:--,_, <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transporters Phone <br /> . . . . . . . . . . <br /> 9.Designated Facility Name and Site Address EVG 10. US EPA ID Number C.Facility's Phone <br /> SAFE] V- KL F. N OF CALIFORNIA <br /> 6880 SMITH AVE. <br /> NFL'ORW. CA 94560 CAD960887418 510-795-4400 <br /> 11.Shipping Name and Description 12.Containers 13. 14. <br /> Total Unit <br /> F—HM No. Type Quantity Wt/vol <br /> a. NOW-RE-GULATED LIQUID (VAC—OIL�WATER <br /> CSLUDGE) (NOT USDOT/NOT USEPA R GULATh) 71 <br /> (NOT CA REGULATED) (POP I <br /> b. <br /> S <br /> H <br /> IC. <br /> P <br /> P <br /> E <br /> R d. <br /> 15.Special Handling Instruction and Additional Information <br /> SK SHIP# 227108245 OR1121.2 <br /> 24H EMERG# 800-468-1760(CH—SK—TFI ).—TRANS AUTH TO RETAIN ADD1L CARRIERS <br /> *78604.?105* <br /> DOT/PRFL ,A. 3299/156097 B. C. D. <br /> A) NONE B) C) D) <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: 11,s is to certify that the above-named materials are properly classified,described,packaged,marked and labeled and are in proper <br /> condition for transportation accordinq to the applicable reaulabors of the Department of Transportation. <br /> Printed/Typed Name <br /> Month Day Year <br /> Be <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on this form are not subject to federal r u a to Transportation or Disposal. <br /> /Typed Name .............. Month Day Year <br /> 111 1 111 jq/ <br /> 6*y 0 9 <br /> T 17.Transporter 1 Acknowledgement of Rece7ippflat Materials <br /> PNt%k VTY ed N a 0 e % Signature Month Day Year <br /> 4 M \ <br /> S .P <br /> P Utg& <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R <br /> T Printed[Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <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 /> 1 <br /> T <br /> Y n�t.dffyped Name Signature Month Da Year <br /> L [ it <br /> nQlr-'IKIAI _PTl IMKI Tn (-_P:K=DATnQ FORM NO.01-90291 (0312015) <br />