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Kr'f'fIkNM�� 2 <br /> t.Shipper's US EPA ID No.(If Applicable) Document Nn,.^ 2 Page 1 <br /> BILL OF LADING/MANIFEST of t <br /> 3.Shipper's Name and Meiling Address <br /> 4.Shipper's Phone( ) <br /> S.Trans er i Company Name 6. US f P4 1D Number A.Transport gq s Phone _ <br /> Y.) DAlt p Y. , LL'0 CA, <br /> "'•('}'"^t <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transport es Phone <br /> ea <br /> 9.Dastnated Facility Namnd ate"3 10. US EPA ID Number C.Facility's Phone <br /> `t `iii#.��1'(��.'&_ I 1 <br /> "a�17 f:"4� �$�F3C•:F: (:1 ��47'41d��a1"7 'tEa .:es�D�+�rC}�� <br /> 11.Shipping Name and Description 12.ContEnem To31al r14. <br /> HM No. Type Quantity <br /> '2- <br /> b. <br /> S (htf"i)" '.r.Gf" f ile Li 1 : <br /> H <br /> t c- <br /> P <br /> P <br /> E <br /> R d. <br /> 15.Special Handling Instruction and Additional Information <br /> LMLaK 880 All PI l fi7 rO RFTA;N L.TCE'UDET) f,1199V duV-N`T Cdti6wRMRS AS NF>rESS Y, <br /> = K J1C' F§1 19038 Be e'lel Ca D% <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: m°momrm'We°t e�r"i0 mie,"1°"imei:'w'e alba�eMor�i°a�'� ��� � <br /> PdnterifTyped Name Monts Day Year <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I certify the malenals daa W shave m thls brrrl are not suhjW to foderai reguletims for Tmnsportaron w DisposN. <br /> •" Pnnted/Typed Name e <br /> MmN De Year a <br /> T 17.Transporter 1 Ackrx medgement of Receipt of Materials <br /> R <br /> '.A PdntedRyped Name Sgnslum Month Ony Ya•r . <br /> P <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R PrimedfTyped Name Siynature Marin Ony Year <br /> T <br /> E <br /> R <br /> 19.DisoreDancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L 20.Facility Owner or Operator:CeN8callon of receipt of metedeis covered by this form except as noted in Item 19. <br /> I <br /> T <br /> Y Pdntedrfyped Name Signeture Mms, Day Year <br /> .r <br /> GENERATOR'S COPY FORM NO.9=1(11/96) <br />