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1'.Shipper's US EPA,ID No.(If Appllcable) Document No. 2..Page 1 <br /> SILL OF LADI.Nl1�liANIFET Cl� lti. .� : 5 0f <br /> 3.Shlppars Name and Mailing Address. r fa - <br /> 1-`2-10 <br /> TRACE CA 95376-3435 <br /> 4.Shipper's Phone <br /> 5.Transporter i Company Name B. US EPA 10 Number A.Transportefs Phone <br /> SAFETY--LEE YSTEM INCI -TXR000081205- . 800-669-5840 <br /> 7.Transpot ter.2 Oompany Name _.......- .. ._..---............ . .._ .-- -- .„ . - US'"' '14 Number --_ - ---.-- sportBr'9 Phone^...,._.,— �'' <br /> 9,Designated Facility NaMe and Site Address SE26015 90. US EPA ID Number C.Facility's Phone <br /> SIEPPORT ENV I RIDNMENTAl..,. U-C <br /> 679 SEAPORT BLVD <br /> REDWOOD CITY CA 9406.E CRI-00042249E 800-321-1030. <br /> 11.Shipping Shame and Description 92.Containers 13, 14. <br /> 701&1 Unit <br /> HM No. Type Quontlty wtNol <br /> a, NOW—RE6U RTED LIOUID (VAG—OIL WATER <br /> SLUDGE) (NOT USDOT f OT USEPA R :GC.f€ ATh) TT S <br /> b. <br /> s - <br /> H <br /> P <br /> P <br /> E <br /> R a <br /> 15.Special Handling Instructlon and Additionat Inform%lon <br /> SK 9HIP0 23116911.8 BR34504 <br /> 24M :Eh ERE-*.:' 800-4-SB--�-1760(CH--�c—�tK' TF I)—TRANG AUTH TO RETAIN AT. DI L- CARPIERS <br /> DOT/PRFL Aa : 3 99/156097 T1s CE D- <br /> A) ! <br /> laA) ' NONE I3) C? D) <br /> D T FIAZA��BUS MATERIALS SHIPPER CERTIFICATION; This Is to omVry that thv a4vve-nam9d ff"6212 Qm pro-pav c aaa1fled,dmd*d,packs�atl,marked and iabeiad a-d aro�n proper <br /> 9 Ga,US <br /> condition fortrans malvn a in h Ifmhlo-ra ula4ore of the Oa Tr na crtat]on. <br /> P0nted(Typed'Name Month Day Year <br /> -iBb.NON-REGU4ATE0 SHIPPER'S CERTIFICATION! I certify the matefials.deaaribed above on K!i form,aro not auto federal regulations far Transportation or Diapoaal. <br /> Pr'nt dlTyped Nam �F - Month D Year <br /> R 97.Transporter 9 Ack wfedgern of Recelpt of Materials <br /> A riotedlTyped Neale &grMro Month Day �Y®sr <br /> N -1- <br /> I Fes' <br /> S 1 <br /> P <br /> 018.Trans rter 2 Acknowledgement of Receilpi of Materials <br /> R <br /> PrintedlTyp - <br /> Signature <br /> ed Name Month DaY Year <br /> E <br /> 99.Diecrepancy Indication Spaoe <br /> F <br /> A <br /> G: <br /> I <br /> I I- 20.Facility Owner or Operator:Certification of seCoipt of materials covered by this forr+i except as noted in It <br /> T <br /> Yrinta (Typed Name Signature Month Day Year <br /> CIHE1. <br /> 24 HR EMIRGENIM 9 800-468A760 <br /> ORIGINAL-RETURN TO GENERATOR FORM NO.'01-90299(0312015 <br />