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GENERATORS COPY FORM N6.01-96291(04/11) <br />BILL OF LADING/MANIFEST hipper's US EPA ID No. (It Applicable) Document N <br />L259G <br />;page 1 <br />C • , .' r <br />3. Shipper's Name, and Mailing AddressFp` "� f KHN.' ; i?j' e 0 4� � <br />of <br />1603 S B ST <br />S T CC TON <br />1 <br />4. Shlpper's'Pitune ( — ­1813, <br />5. Trag'nysportery1 Company Name 6. US EPA ID Number <br />A. Transporter's Phone <br />[ aygs p�S gp J 2, <br />i'it..�.EIE�.'F""A`4�.,:eEE€'�$ SYSTEMS, , INC. �4%•€SE::Pf 4�Ei.d'�� t,'f. <br />g <br />'327iR�� S4,:F &<g0kCP�..e3 <br />7, Transporter 2 Company Name 8. US EPA ID Number <br />B. Transporter's Phone <br />9. Designated '. Facility Name and Site Address 1 2�4 -1 10.' US EPA ID Number <br />C. Facility's Phone <br />3077 HUN'CW6d5 . AVE <br />11. Shipping Name and Description <br />12. Containers <br />13. <br />14. <br />HMTotal <br />a SNI VERSA._ WASTE LAI <br />No, Type <br />Quantity <br />Unit <br />Wt/Vol <br />(FLUORESCENT LA ) <br />'..." <br />F <br />b. <br />S <br />H <br />C. <br />P <br />P <br />E <br />R <br />d <br />15" Special Handling Instruction and Additional Information <br /># I <br />15K S � P A...�r.u•iFJst,`.; , '�e�<��`:fi'f`:,`Y <br />1 �eSi3..= 8 6571 <br />�^ g^ y' g' & ,+�� .} �1 q gam { <br />G. 10 <br />168. US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION' This is to certify that the above-named materials aortare property classifietl, described, packaged, marked and labeled and are in proper <br />• condition for trans tion <br />according to the a [!cable re ulations of the De artment of Trans ortation. <br />Printed/Typed Name <br />r e• <br />Month Day <br />Year <br />16b. NON-REGULATED SHIPPER'S CERTIFICATION certify the materials described above on this form are not subject to federal <br />regulations for Transportation or <br />Disposal. <br />Printed/Typed Name <br />.. <br />Month Day <br />Year <br />T <br />R <br />1�/. Trans orter 1 Acknowh d` <br />P gam# of,Receipt of Materials <br />A <br />S <br />P ' eed/Typed Namet Signature , <br />r <br />�f <br />Month Day <br />Year <br />o FFF <br />O 18. <br />Transporter 2 Acknowledgement of Receipt of Materials ' <br />T <br />Printed/Typed Name <br />re <br />E <br />Month Day <br />Year <br />R <br />19. <br />Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L 20. <br />I <br />Facility Owner or Operator: Certification of receipt of materials covered by this form except as noted in Item 19. <br />T <br />Y <br />Printed/Typed Name <br />Signature <br />Month Day <br />Year <br />GENERATORS COPY FORM N6.01-96291(04/11) <br />