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GVEOLIA Is <br />ENVIRONMENTAL SERVICES <br />GENERATOR /SHIPPER'S INITIAL COPY <br />1: Generator ID Number rg cY Response Phone <br />SHIPPING 2 Page i of 3. F�the en Shipping Document Traddng Number <br />DOCUMENT <br />DOCUMENT r n , i 'd <br />1.1. <br />(07' o a_in ; ` 00273536 <br />5. Generators Name anMailing Address <br />wt ..;-ZZ <br />Generafdrs SiteAdifress (d different than maRng address) <br />C; F Allii i jSe <br />1 t i I; iii ,"IA 1 <br />�'i <br />�UFOR IA.WER S VICI= <br />I= EAS LWAYE� VAN97 <br />SAN Jt7SE, <br />Generators Phone: iib 357--8377 <br />STOCKTON, CA 08$106 <br />6.Transporter i Company Name <br />U.S. EPA ID Number <br />VEWA INDUSTRIAL SERVICES <br />� � R C � <br />r] � � 2 � 4 0 <br />7. Transporter 2 Company Name <br />U.S. EPA ID Number <br />8. Designated Facility Name and Site Address i y <br />ALTr�MONT LAND -FILL <br />U.S. EPA ID Number <br />113$49 A.LTANIONT PASS ROAD <br />FarmysPhone: 921 Ad -Z71116 71116 LIVERMORE, C& 94660 <br />1 S 8 2 2 <br />ga. <br />HM <br />gb. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />and <br />and Padang Group (d any)) <br />10. Containers <br />11. Total <br />12 Unit <br />13. Codes <br />No. <br />Type <br />Quantity <br />WL/Val. <br />Cr <br />1. <br />HA-7A 5(,US MATERIAL, (FIJIE .01L NC1. u, SAN0-1NON <br />'!M <br />V6 <br />LU <br />2 <br />C7 <br />T--_ <br />3 <br />4 <br />14. Special Handring Instructions and Additional Information <br />ER StN10 COMM <br />bY VESTS 1) W243730 A:,-LT6068 3C:,s <br />15. GENERATOR SIOFFEROR S CERTIFICATION: 1 hereby declare that the contents of this consignment are fogy and accurately described above by the proper shipping name, and are classified, packaged, <br />marked and labeled/placarded, and am in all respects in proper condition for transport according to applicable international <br />and national govemmentai regulations. <br />eneratoesl0 eros an yp ameon <br />1`W ! A � t <br />gn �—<sl f <br />ay ear <br />- <br />J <br />i i J fl <br />16. International Shipments <br />ElImportto U.S. ❑ Export from U.S. Port of enhy/exp <br />. <br />Transporter sinature for exports only): <br />Date leaving U.S.: <br />LU <br />17. TransporterAdmoviledgment of Receipt of Shipment <br />LL <br />Transpo ar l Pdntedlfy )ed Name / 'f/ <br />nalum _ Month Day Y <br />1 J r is <br />I t�( Lr' t i 1 <br />pal <br />Transporter 2 Print" typed Name <br />Signature <br />Month Day Year <br />t- <br />18. Discrepancy <br />18a. Discrepancy indication Space ❑ Quantity [:]Type YP <br />❑Residue ❑Partial Rejection <br />❑Full <br />Rejedfon <br />18b. Alternate Facility (or Generator) <br />Shipainq DocumentTra Number. <br />3 <br />U.S. EPA ID Number <br />0 <br />Foca s Phone: <br />18c. Signature ofAltemalbe Facility (or Generator) <br />a <br />Month Day Year <br />z <br />19. Report Management Method Codes (i.e , codes for treatments disposal, and recycling systems) <br />0 <br />1 2 <br />3. 4 <br />20. Designated Facility Owner or Operator. Certification of receipt of shipment except as noted in Item <br />18a <br />Printedfryped Name <br />Signature <br />Month Day Year <br />GENERATOR /SHIPPER'S INITIAL COPY <br />