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BILL OF LADING/MANIFEST 1 Shipper's US EPA ID No.(If Applicable) Document No. 2,page 1 <br /> _ 7 of <br /> 3.Shipper's Name and Mailing Address Burrs Truck and Trailer <br /> P.0. B O x 239 <br /> RIPON CA 95366-0000 <br /> A.Shipper's Phone( e@91-599-2662 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporter's Phone <br /> SYSIll <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transporter's Phone <br /> CLEAN HARBORS ENV SVC INC. MAD@39322. 50 781-792--5000 <br /> 9.Designated Facility Name and Site Address SCA 10. US EPA ID Number C.Facility's Phone <br /> SAS=E:7 Y-KL.f~EN SYSTEMS, INC. <br /> 6000 88TH STREET <br /> SACRAMENTO CA 95828 CA0000084517 916-386-491,3 <br /> 11.Shipping Name and Description 12.Cont finers 13. 14. <br /> Total Unit <br /> HM No. Type Quantity Wt/Vol <br /> a. <br /> H <br /> 1 C. <br /> P <br /> P <br /> E <br /> R d. <br /> 15.Special Handling Instruction and Additional Information <br /> SK SHIP# 230940973 SU 14691 <br /> burns Truck and Trailer <br /> ).496 Santos Ave <br /> RIPON CA 95366-0000 <br /> 24H EMERG # 800'--468-'1760(CH-SK--TFI)-TRANS AUTH TO RETAIN ADDS L CARRIERS <br /> DOT/PRFL. A. 7622830/157154 B. C. D. <br /> A) NONE B) C) D) <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: "This is to certify that the above-named materials are properly classified,described,packaged,marked and labeled and are in proper <br /> conditig,to Leonaccordi to the atiplicable r •ula[ions of the Devartment of Transl3ortation. <br /> Printed/Typed Name Month Day Year <br /> 16b.NON4qiGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on tf+3 form are not subjectfo'f er�4 tit ins for Trans prtati�cror Disposal` <br /> •- <br /> Printe pec(Krame , �.. Month -Day Year <br /> T 17.TrAslJorter 1 Zknowledgement of Receipt of Materials <br /> R <br /> A P to , ^ped Name(�) Signa r / Month Day Year <br /> N <br /> -- ' .2. <br /> P t <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials 1 <br /> R Printed/Typed Name Sin u <br /> T yp 9 Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 <br /> L 20.Facility Owner or Operator:Certification of receipt of materials covered by this form except as noted in Item 19. <br /> 1 <br /> T <br /> Y Printed/Typed Name Signature Month Day Year <br /> GENERATOR'S COPY FORM NO.01-90291 (03/2015) <br />