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I <br /> i <br /> BILL OF LADING/MANIFEST 1.Shippers US EPA ID No.(If Applicable) Document No,,, 2.Page 1 <br /> (�Al79a�w�17.3� - � � of <br /> 3.Shipper's Name and Mailing Address -. i a n S Snop - C <br /> 1603 CS 13 St <br /> STOCKTON CA 955 --''06--24 76 <br /> 4.Shipper's Phone( ' ��j_sdat 1E31.:3 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transportar's Phone <br /> 9Af--E3Y--,KI-EC:.N 'YSTEM IN(.; TXR01161 101131. 01,13. 9i; 2f,r---r.'_Q)(40 <br /> B.Transporter's Phon7.Tr VA Cf4'A�§eS ENVIRONMENTAL. 3 L JNCaffD 1Ar2,? 0 e qi�?--woI <br /> 9.Designated Facility Name and Site Address Si10. US EPA ID Number C.Facility's Phone <br /> CLFAN t•dtiftBORS SAN .JO,F". <br /> 1021 BERRYE'ISSA ROAD <br /> BAN ,JOSE: CA 951,33 CAD0 9494 i 10 408-441 -0136i) <br /> 11.Shipping Name and Description 12.Containers 13. 14. <br /> Tote Unit <br /> HM No. Type Quantity WWol <br /> a. <br /> IJNP-795 BATTERIES WET FILLED WITH ALKALI, <br /> X 8 WNItIE:RSAT.. WASTE BATTERIES} �Ip. {; ! <br /> I (E Ria#154) <br /> b. <br /> S <br /> H <br /> C. <br /> P <br /> P <br /> E <br /> R d <br /> i <br /> 1 <br /> 15.Special Handling Instruction and Additional Information <br /> 5r< aH T Poi 22698P133# i' C:�°`t•�lE3r'.'c""., <br /> 1 )E RG#1541 <br /> E411 E.MERC3# € UTH TO RE AJN ADW L CAPRTF:RC-� i <br /> D0'i'1Pf2FL A. Fii'315t39l1 3t fsil�F3 33• (~. i�• <br /> A) NONE- A) C) D) <br /> i <br /> i <br /> i <br /> I <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: -This is to ceAry that the above-parted materials are property classified,described,packaged.marked and labeled and are in proper <br /> condition for ba don ecrordm to mea i-able repulatkins of the Department of Tran "on. <br /> PrintedtTyped 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 /> Printed/Typed Name <br /> IMonth Day Year <br /> T <br /> R 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> A Phrtted/Typed Name Signature <br /> N -{ I Month Day Year <br /> P e <br /> 0 18.Transodi er 2 Acknowledgement of Receipt of Materials i <br /> RPrinted/T ed Name <br /> E YP Signature -' Month Day Year <br /> R <br /> 19.Discrepancy Indication Space <br /> i <br /> F 1 <br /> A I! <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 /> Y Printed/Typed Name Signature Month Day Yearloll, i <br /> i <br /> '11 vl i <br /> I <br /> GENERATOR'S COPY FORM NO.01-90291(03/2015) <br />