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�A ��G��AN�F�� 1.Shipper's US EPA ID No.;(!f AppucaEele) bocument No 2.Page 1BILL OF ; <br /> z <br /> 3.5hlppers Name and Malling AddressOf <br /> � op.. 4)011 W <br /> , r TV— <br /> S. .a <br /> CA 9- 55 06-10:1476 <br /> 4._5hlpper's.Phone( <br /> 5.Transporter 1 Company Narhe 6.. US EPA-ID Number A.Transporter's Phone <br /> 7.Tr r C� 3R f L ������� � � � ��a�� D��ib r�a°�nS B.Transporters Phorl ��1 7 ;�Y .�F �o <br /> 9.'Designatod Facility Name and Site Address , - 10, US EPA.ID Number C.Pacillty's Phone <br /> i :,4 ... 0. <br /> 11:Shipping Name and Descripticn 12,Cont iners 13.. 14, <br /> HM d . g Total <br /> Type Quantity WWt/Volnito_l <br /> a' .yklry ^WiA tl. y7 Xwgp4 ` <br /> 4 ` t a)4 . <br /> b r <br /> `S <br /> H , <br /> R d. <br /> 15.Speclal Handling Instruction and Additl.orta!Information <br /> 961 it : S 4 41 P# 825,9 6 251 7 <br /> A48 z <br /> 24H 608":468-1.760 i IA—W TFT)".TRANS AUTH TO REMIN ADD' L, C AR ERS <br /> QT/P;'K, - 8291514 9/1.11,58 S. C. <br /> NONE 0S Aa <br /> 16a;US DOT HAZARDOUS MATERIALS 5HIPPER'S.CERTIFICATION: "This is to certlfymat the above-namgd male als areproperly classified,descritietl,packaggd,merkod and labeled and are in proper <br /> condition for trans brtatlon accordln So thea lJoahle ra ulallons orlhe Qe ertmentoF hens Orta{Ion, <br /> Printe47yped Hamer, <br /> Month Day Year <br /> 1/1'/ t I, <br /> 96b NON-REGULATED SHIPPER`$CERTIFICATION:.Lcertify the materials described,above on this form are not subject_to federal ragulatiops for Tra sportalion or bisposal, <br /> PrintedlTyped Name ' Month Day Year " <br /> R 17.Transporter 1 Acknowledgement of Receipt Of Materials <br /> A P.Ir�tedlTyped a"we Signature s Month Day Year <br /> N fly 7L � } <br /> 0 18;Tran06 er.2 Acknowledgement of Receipt Of Wterlals <br /> F2 T PrintedlT ed Name Yp Signature .. <br /> Month Day Year._ <br /> F7 <br /> 1%Discrepancy nridlaadon Space <br /> F <br /> A <br /> ,C . <br /> `E <br /> 29.Faculty Owner or Operator:Certification of receipt of materfals covered by this form except as noted In Item 19. <br /> T <br /> Y PrintedlTyped Name Signature Month Day Year <br /> r,P:KiFRATr1Riq r..npv FORM No.01-9a?A1 rnwl <br />