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--�7-Shipper's US EPA Q No.(if Applicable) page 1 <br /> Al OP LADING/MANIFEST T <br /> of <br /> QQ1 00039A73171 <br /> 3,-ShippeesNarne and Mailing Address Paradise Point Marina <br /> 8095 Rio Blanco Rd <br /> STOCKTON CA 95219-8703 <br /> 4.Shippers Phone 209r952-1000 <br /> 5.Transporter I Company Name 6. US EPA ID Number A.Transporter's Phone <br /> SAFFTY—KI-FEN SV5;1Ftd1; TWIC -Txwoyiowpm — q7P—Pr-.R-200 <br /> 7,Transporter 2 Company Name 8., US EPA ID Nurriber B.Transporter's Phone <br /> CLEAN HARBORS ENVIRONMENTAL SRVICES-. I.NCMAD039322E!50 781-792-50 <br /> 9.Designated Facility Name and Site Address Si10. US EPA ID Number C.Facility's Phone <br /> CLEAN HARBORS SAN JOSE <br /> 1021 BERRYESSA ROAD <br /> SAN JOSE CA 95133 CAD059494310 w 408-441-0962 <br /> 11.Shipping Name and Description 12.Containers 13. 14. <br /> Total Unit <br /> i IM No, Type Quantity Wt/\/Oi <br /> UN1950 AEROSOLS FLAMMABLE N. O. S. , <br /> X 2. 1, UI IVERSAL WhSTE—AEROSOLS om 00 P <br /> b. <br /> H <br /> I C. <br /> P <br /> P <br /> E <br /> R T <br /> 15.Special Handling Instruction and Additional Information 2ZZZ-0-��7 <br /> SK SHIP# PA23059 <br /> 1)ER(3#126- <br /> 24 HR EMEAGENCY #1-800-468-1760 (SK TFI) <br /> RUTH AS "ASENT—FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSAR <br /> DOT/PRFL A. 7939644/1403672 B. C. D. <br /> A) NONE B) C) D) <br /> p <br /> Ili,�,I—tity O�th. W--d mawriats Able <br /> da-rhod,d—bod,padlagad.—ked�d labeled—d are m pmpw <br /> Ifia.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION; oDnCW;n forts �dim to Ow amA"ble mmtabo�of the Depa�wnt 0 Tmnspodafim <br /> Printedffyped <br /> 4arne U th Day Year <br /> 16b.NON-REGULAT9D SHIPPER'S cER-l-trICATION. I certify the materials described above on this form are not subject to federal regulations for Transportation or Disposal. <br /> Printed/Typed Name Month Day Year <br /> T 17.Transporter I Acknowledgement of Receipt of Materials <br /> R <br /> A ted/Typed N&e Signature <br /> NIM h Day Year <br /> S 7 <br /> P <br /> 0 18.Trans2 Acknowledgement of Receipt of Materials <br /> R <br /> T Signature Monti Day Y..l, <br /> r <br /> 19.biscrepancy indication Space <br /> F <br /> A <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 /> 1 <br /> T <br /> Y Printed[Typed Name <br /> Signature Month Day Year <br /> ORIGINAL-RETURN TO GENERATOR FORM NO.01-90291(0312015; <br />