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2-28-08; 1:29PM;RYDER TRUCK STOCKTON ;2099433340 # <br />3/ - <br />BILL ANG/MANIFEST Shipper's US EPA 1D No. (IFApplicable) Document N . Page 1 <br />Df <br />3. Shipper's Name and Mailing Address <br />o-' <br />4. Shipper's Phone ( ) <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />A. Transporters Phone <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />B. 7ransptxter's Phone <br />:< <br />9. Designated Facility Name and Site Address 10, US EPA ID Number <br />C. Facility's Phone <br />7 <br />11, Shipping Name and Description <br />12. Containers <br />13. <br />14. <br />HM <br />No. <br />Type <br />Total <br />Quantity <br />Unit <br />Wt/vol <br />a. <br />tt <br />i <br />b. <br />S <br />H <br />1 <br />c. <br />P <br />P <br />E <br />R <br />d. <br />t. <br />15. Special Handling Instruction and Additional Information <br />t "`"'T f:' �/T4105-,'!8.i. 'q9 000'.e--'15017-6.6 <br />rr, <br />EP1E.'R, >�.IIC. Fitk`: f� i�C) cx� � ],"!t':i)i, 2�1 13t2 :k l PdGI;T; <br />,t . <br />23•'. CORP AUTIRIlP:l"i; l) TO RE` AT..N 1, 3: C: I5t'ISk;i7 ���3JS�i?�.flat�i`X' .'73{718 1 r,EiS A <br />,? Ic. FV O'.ti 4 /k., . 3. 4. i1 ). 1 t 11 - <br />16a. US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION' 'This Is to certify that the above-named materials aro property classified, described, packaged, marked and labeled and are In proper <br />• condition for trans ortation accordin to thea likable reulallons of the Department of Transportation. <br />RdntedlTyped Name <br />Month Day <br />a• <br />Year <br />16b. NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on this form are not subject to federal regulations for Transportation or Disposal. <br />- <br />Printed/Typed Name Month Day <br />Year - <br />�• <br />R <br />R <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />A <br />PrirjW[T.yped Name <br />Signature14 Month Day <br />Year. <br />100 <br />O <br />18. Transporter 2 Acknowledgement of Receipt of Materials ! _ `-•. <br />T <br />Printed/Typed Name <br />Signature Month Day. <br />Year . <br />R <br />�!- <br />19. Discrepancy Indication Space <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 />" i Y <br />�i <br />Printed/T ed Name <br />YP <br />Signature Month Day <br />Year <br />IN EVENT <br />ti''tj, LL - <br />OF EMERGENCY UA IR <br />1.800-468-t760 <br />eS <br />GENERATOR'S COPY F'0RM No 90291 <br />(11796) <br />