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BILL OF LADING/MANIFEST 1,Shippers US EPA ID No.(If Applicable) I Document No. 12.Page 1 <br /> of <br /> 3.Shippers Name and Mailing Address <br /> q, y <br /> -A <br /> TON <br /> 4.Shippers Phone <br /> 5.Transporter I Company Name 6. US EPA ID Number A.Transporters Phone <br /> E:qFETV—KL,EEN SYSTEMS INC <br /> P <br /> h <br /> Phone <br /> 7.Tra rt 2 Company Name US EPA ID Number B.Transporters Phone <br /> In'CLTIFT-•'i Hnnclps R,0r-,Jti,1E-NT1 AL S-Vf .1 NC. 0 0 jA <br /> 9.Designated Facility Name and Site Address C.Facilitys Phone <br /> 110. US EPA ID Number <br /> 1.6--1 BERRYE�Ic.'3,M ROAD <br /> AN JOSE A 95133 Q A D 0 5 9 4 94'<10 4 08--4 it I <br /> 11.Shipping Name and Description 12.Containers 13. 14. <br /> . Unit <br /> Type Quantity wtivoll <br /> —HM-1 No. Total <br /> a. NON--REGUL.P,M) MPTERTAL, (METAL. -BRAKE <br /> SHAVINGS) P <br /> 5 0. <br /> b. <br /> tf <br /> F, <br /> -P <br /> E. <br /> 1S.-'SpecI0I!HaqdIirg instruction and Additional Informatipn <br /> OR 14,38 4- <br /> SK Sf41k 224604446 <br /> -P4 HP EMERGENCY. #I-71310le-468—176,10 CH SK / TFT <br /> AUT-H' AS "AGENT."FOR" ,:BY GEN TO RE.T.A.M.: LICENSED SUB CAR R-1 ERS AS NECESSAR...., <br /> PRFL P.- 7432418/646971 B. Cill D. <br /> -DOT/ <br /> -A): NONE. B) C) D) <br /> lop.,us S M�ATFRIALS15HIPOFRIPCERTIFICATION: wK".i`n pover <br /> CbMWdnWto in <br /> Printiddr­ Aerie. Day <br /> io iEG Op MjIPPERS CERTIFICATION:�ICA�WO SP4* <br /> to federal regu onsforTran cip of o1sposat'. <br /> Pri ht6dn 4ame Month Del year <br /> 1 e4 c.t:l <br /> = 4 <br /> 17.TraVspiorter I Acknovitledgement cf-Romlipt-of-Mat"Sir <br /> A <br /> .Month Day vill"r, <br /> rited/Type affie <br /> :N * lignaltd-rell- <br /> S <br /> P - <br /> .0 18.Trani 2 Acknowledgement of Receipt of Materials <br /> T P RWT id NIM Signature Month Day Yisr <br /> IE <br /> R <br /> M :J � I.&I <br /> 19.blisprepancy Indication Space <br /> .A <br /> c <br /> I <br /> -L 20.Facility Owner or Operator:Certification of receipt of materials covered by this form except as noted in Item 19. <br /> I <br /> T <br /> Printed/Typed Na Signa. <br /> a <br /> NOW j 17. <br /> IN <br /> MENEM= <br /> A I Milli <br />