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1 11 <br />S <br />H <br />I <br />P <br />P <br />E <br />R <br />i. bnippersUb tt-A IUlvo. pTApixlCaoaet 2 Page 1 <br />BILL OF tAI�INCIMANiFEST of <br />3. Shippers Name and Mailing Address PANELLA <br />5000 E MONT ST <br />AVIS <br />V <br />STOCKTON <br />CA <br />95205 <br />43- <br />4. Shippers Phone( 2109 )943-50130 <br />5. Transporter 1 Company Name 6. <br />5. <br />US EPA ID Number <br />A. Transporter's Phone <br />7. Transporter 2 Company Name 8. <br />US EPA ID Number <br />B. Transporters Phone <br />9. Designated Facility Name and Site Address 10. <br />US EPA ID Number <br />C. Facility's Phone <br />AERC'COM INC. <br />30677 HUhTWOODAVE <br />HAYWARD CA 4 CAD98.241.1993 <br />510-429-1129 <br />11. Shipping Name and Description <br />12. Conte <br />iners <br />13. <br />Total <br />14. <br />Unit <br />HA1I <br />No. <br />Type <br />Quantity <br />wUVol <br />a. <br />I L» WASTE LAMPS <br />I <br />JUN <br />(FLUORESCENT L ) <br />CF <br />940 <br />P <br />07 <br />b. <br />C. <br />d. <br />15. Special Handling Instruction and Additional Information <br />SK SH I P# -272030'7 <br />24 HR EMERGENCY #1-80101-468-1760 ( FET -KL94138 <br />A) NONE <br />C AUTHORIZED TO RETAIN LICENSEDi T CARRIERS AS NECESSARY <br />DOT/PRFL A. 14815/150228 C. D. <br />$a: US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: coubp. ®ordteqliabln r transportationaccording omaapplicable <br />Printed/Typed Name <br />16b. NONREGULATED SHIPPER'S CERTIFICATION. I certify the materials described above on this form are not subject <br />Printed/T me <br />s <br />17. Trans 1 Acknowiedge of Receipt of Materials <br />X Print yped ►Jam r'" Signa <br />d <br />P <br />O 18. Trensoorter2 Ack edsaement of Receipt of Materials <br />19. Discrepancy Indication Space <br />20.-Fa0lity Owner or Operator: Certification of receipt of materials covered by this form except as noted in Item 19. <br />Pnntkdflyped Name Signature <br />GENERATC <br />and labeled and are in proper <br />Month Day Year <br />or Disposal. <br />Month Day Year <br />U b S I/ <br />Month Day Year. <br />Month Day Year <br />. I I <br />FORM NO. 01-90291 (1.1/09) <br />