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GENERATOR'S COPY FORM NO. 01 -90291 (04111) <br />1. Shiooei*s US EPA ID ivu. k%Applicable) Document No. <br />BILL OF LADING/MANIFEST <br />2. Page 1 <br />I <br />Of <br />3. Shipper's Name and Mailing Address M 13E R I--- W C` (11 R P. <br />? '4 MARTIN [.11THER T N [3 Bl1i <br />4. Shipper's Phone <br />5. Transporter 1 Company Name <br />6* US EPA ID Number <br />A. Transporter's Phone <br />SlhV_E_TV--+Q_EFN SY94MS., <br />i. N117'. <br />7. Transporter 2 Company Name <br />8. US EPA ID Number <br />B. Transporter's Phone <br />9. Designated Facility Name and Sit�A d1,ss <br />740 1 10. US EPA ID Number <br />C. Facility's Phone <br />E, 9F- <br />f <br />tj 1 Nif - <br />17E,_2 OPE-il) CREETEX <br />R6111) <br />DENTON, T <br />76208 T X D t 1 1 <br />11. Shipping Name and Description <br />12. Containers <br />13. <br />14. <br />Total <br />Unit <br />F_HM <br />No. <br />Type <br />Quantity <br />Wt/Vol <br />a, <br />RF*_`_,I <br />N E T) <br />10 <br />P <br />4 <br />(J <br />b. <br />13; l 0-- a f -,C I <br />06r,-, T NiFID <br />1 <br />42 <br />56 <br />P <br />S <br />H <br />I <br />c. <br />P <br />P <br />E <br />R <br />d. <br />15. Special Handling Instruction and Additio al Information <br />SK 'SHIP -0 2049329;.R7 <br />137 L 8,3 <br />c'-.'4 HR EMERGENiCY1 #1-81210-468-1760- (SAFETY--K1,_EEN <br />— CnNTF.IACT K`14i38) <br />C, 71 <br />Sri, AITTIV D T0, U.�X_ 5UBSFQUENT CARRIERc-.41078, 414i 11, 816-81,31'R73fj, <br />8353' T3 <br />P0T/PRFL.. A. 16171/1150169 B. 161.7/150169 C. D. <br />C) D <br />16a. US DOT HAZARDOUS MATERIALS SIPPER'S CERTIFICATION: 'This is to certify that the above-named materials are properly classified, described, packaged, marked and labeled and am in proper <br />H condition for trans enation accordina to the applicable re Mations of the Department of Transportation. <br />Printed/Typed Name <br />Month Day <br />Year <br />16b. NON-REGULATED SHIPPER'S CERTWICATION: I certify the materials described above on this form are not subject to federal regulations for Transportation or Disposal. <br />Xted/Type I Name <br />Mo th Day <br />Year <br />T <br />R <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />A <br />N <br />Pri e /Typed Name <br />Slgnatuce,� - <br />Month Day <br />Year <br />1i <br />S <br />P-5 <br />P <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />R <br />T <br />Printed/Typed Name <br />Signature <br />Month Day <br />Year <br />E <br />R <br />I <br />19. Discrepancy Indication Space <br />IF <br />A <br />C <br />I <br />L <br />1 <br />20. Facility Owner or Operator: Certification of receipt of materials covered by this form except as noted in Item 19. <br />T <br />1 <br />Y <br />Printed/Typed Name <br />Signature <br />Month Day <br />Year <br />GENERATOR'S COPY FORM NO. 01 -90291 (04111) <br />