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BILL OF LADING/MANIFEST Shipper's US EPA 10 No.(IfAppllcable) Document 2.Page 1 <br /> T:R�I- !0I i4c�7i 4 5 of 1 <br /> 3.Shippers Name and Mailing Address yi0f11 c,..FRE.til1((`I AVE <br /> STOCKTON CA c?`'r203 <br /> 4.Shipper's Phone( 209 460 0791 ~ <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporters Phone <br /> FAFE'TY—KLEEN SYSTEMS, INC. 3-X.r 0.01115@930 800 6E9--5840 <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transporters Phone <br /> 9.DPsipryyed Ulty Naj..e and Site Address 10. US EPA ID Number C.Facility's Phone <br /> t 6F7 H NTWOU AVE <br /> HAYWARD CA 94544 C:AP98241i993 510 429'-1129 <br /> 11.Shipping Name and Description 12.Containers 13. 14, <br /> HM No. Type Quantity Unit <br /> a. a <br /> tivol <br /> (FLLIURESCENT LAMPS) CF P <br /> b. <br /> 20 <br /> S <br /> H <br /> I c. <br /> P <br /> P <br /> E <br /> R d. <br /> S.Special Handling Instruction and Additional Information <br /> MFST RfT#111199737 017103._0796_..71 <br /> E MERBE:NCY. RESP 800—!468-'17150 (c 4 HR) , A) NONE <br /> SK CORP AUTHORIZED TO RF--rATN LICENSED SUBSEQUENTCARRIERS AS NECESSARY. <br /> SKDOT# Aa 14815 R: C2 Da <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: ThI"dio umry wure..oe-naread mnadaiaare orownrdexlrud,duonbad,pecxao-.n ,*oa aI... no.,.A+ opa, <br /> mnmuo�mrwna owudn aaomi mu+ea I abiare Wanda dt mao amain 0 Tmoa oris... <br /> PrinteOlTypetl Name <br /> Month Day Year <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I oertlfy the materials described above on this larm are not subject <br /> Printed/Typed Name to federal regulations for Transportation or Disposal, <br /> a. <br /> _ Month Day Year <br /> T <br /> R 17.Transporter 1 c nqwIqdgsment of Receipt of Materials <br /> A Prinled/Typed N <br /> N ,3 nature ✓! Mpgth D9y Y ar <br /> P <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> T PrintedlTyped Name <br /> Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 <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 Pdmad?ypetl Name Signature <br /> Month Day Year <br /> 21 LWAOYTI <br /> :il •1 <br /> GENERATOR'S COPY FORM NO.01-90291(9108) <br />