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1.Shippers US EPA ID No.(If Applicable) 2.Page 1 <br /> BILL OF LADING/MANIFE3T GAL 000 1 01,=7,� of <br /> .4 -tJ ' * * - <br /> 13GIL-L ANIMAL T ON <br /> 3.Shippers Name and Mailing Address� -), NUTR 1 <br /> 4-344 S EL DORADO ST <br /> SrOCKTON CA 95206-4904 <br /> I Shippers Phone 09 _34-4439 - <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporters Phone <br /> LK -L ­YSTE.Mr-' INC. I _L65-2000 <br /> 7,Transporter 2 Company Name 8. US EPA ID Number B.Transporters Phone <br /> . . . . . . . . . . . <br /> 9.Designated Facility Name and Site Addr"iss '132471 10. US EPA ID Number C.Facility's Phone <br /> AERJIF <br /> C 'OM IN <br /> 3-677' HUW'WOO AVE <br /> HAYWARD C 94544 CA D98 22 41 1.993 <br /> 11.Shipping Name and Description 12.Containers 13. 14 <br /> Total Unit <br /> HM No. Type Quantity Wt/Vol <br /> a. IN I VERSAL <br /> WASTLAMPS <br /> 1-7 I.IIDRESC�NT LAMPS) <br /> e3 <br /> b. <br /> S <br /> H <br /> I c. <br /> P <br /> P <br /> E <br /> R <br /> J. <br /> 15.Special Handling Instruction and Additional Information <br /> SK 31-41P# P-04390091 3387201 <br /> 24 HR EMEFGENCY #1-800-466-1-760 (SAFETY-KLEEN CONTRACT #94138) <br /> SK AUTHORIZED 10 RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY <br /> DOT/PRFL A. 14815/150228 B. C. D. <br /> A) NONE B) C) D) <br /> This Is to certify that the above-named materials am properly classified,described,packaged,marked and labeled and are in proper <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: -Tcondition for trans ortation accordin to thea licable regulations of the Department of Transportation. <br /> Printed/Typed Name Month Day 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 /> %f,nted/Typed Name A Month Day YearM­�- I -6i Z-yl I/ <br /> R 17.Transporter 1 Acknowledgement of RaPd K of Materials <br /> A tfn.ntedffyppd Nam? Signature M0 h D r <br /> N <br /> S a y <br /> 0 18.Transporter 2 Acknowledgement of Race Pt of Materials <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 /> L 20.Facility Owner or Operator:Certification o receipt of materials covered by this form except as noted in Item 19. <br /> I I <br /> T <br /> Y Printed/Typed Name Signature Month Day Year <br /> ORIGINAL-RETURN TO GENERATOR FORM NO.01-90291 (11/09) <br />