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1. Shipper's US EPA ID No. (If Applicable) Document No. <br />2. Page 1 <br />BILL OF LADING/MANIFEST <br />of <br />f,�:r•-a , <br />3. Shippers Name and Maiiing Address STO(KTON RUBBER Mr-6 CO T NC <br />- 5023 N Flood Rd <br />. <br />Linden CA 95236--9455 <br />4. Shippers Phone( <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />A. Transporter's Phone <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />B. Transporters Phone <br />9. Designated Facility Name and Site Address 7 i.'r 1 10. US EPA ID Number <br />C. Facility's Phone <br />YS M".3, ,NG.C7000 <br />88 TH STREET <br />SACRAMENTO t O S. A 95828 ['.A]0100006451 6451 t <br />916-386--4913 <br />11. Shipping Name and Description <br />12. ContE <br />iners <br />13. <br />Total <br />14. <br />Unit <br />HM-1 <br />F- <br />No. <br />Type <br />Quantity <br />WWoi <br />a. <br />DRAIN LJSF-.,.D CIL FILTERS <br />b. <br />S <br />H <br />I <br />C. <br />P <br />P <br />E <br />R <br />7- <br />15. Special Handling Instruction and Additional Information <br />yy j g yy <br />2A HR EMERGENCY #1­800­468­1760 (SQFEiY-+'J N M- <br />C N'rRACT #94138) <br />SK AUTHORIZED TO RETAIN LT6...Ei` SED�. BSEQ ENT U'IRRIERS AS NECESSARY <br />DO f <br />@gg"�'++'��89 1 ^BB.P."@@'�' r 6g/ 1'5 d. fS f B. Cw DC <br />}}$• p�..3p''g$}'�,•4L, <br />A) i�S.EC�E 8) 6;,a d R.F J <br />1. <br />168. 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 />condition for transDortation'accordin the applicable rreeaulations of the Department of Transportation. <br />Printed/Typed Name <br />Month Day <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 />•'tedffyped <br />Name <br />Month -jrD <br />Year <br />. <br />l <br />T <br />17. Tra sporter 1 Ackno edgement of Receipt of Materials <br />R <br />AIF <br />nt d/Typed Nam <br />Signature r -..,�, <br />Month Day <br />Year <br />1,„„ <br />P <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />TPrinted/Typed <br />Name <br />Signature <br />Month Day <br />Year <br />E <br />19. Discrepancy Indication Spat <br />F <br />A <br />C <br />I <br />L <br />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 <br />Printed/Typed Name <br />Signature <br />Month Day <br />Year <br />• <br />GENERATOR'S COPY <br />FORM N0.01-90291 (04h1) <br />