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1.Shipper's US EPA ID No.(If Applicable) J� Document No. 12.page 1 <br /> BILL OF LADING/MANIFEST <br /> il-�L.4�0a08798L.� . of <br /> 3.Shippers Name and Mailing Address San I Pak Inc <br /> Po Pox 1183 <br /> TRACY CA 95378-1183 <br /> 4.Shipper's Phone( 209F835--31.04 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporter's Phone <br /> S A - T —is` EEN ST MS [NC - -r.h� -285ii <br /> 7.Transporter 2 Company Name 8. . US EPA ID Number B.Transporter's Phone <br /> CLEAN HARBORS ENVIRONMENTAL S C INC. MAD03932.2250 781-792 -lb414:4? <br /> 9.Designated Facility Name and Site Address W I 10. US EPA ID Number C.Facility's Phone <br /> CLEAN HARBORS OF WILMINGTON LLC <br /> 1737 EAST DENNI STREET <br /> WILMINGTON CA 90744 CAD044429835 310-835-9998 <br /> 11.Shipping Name and Description 12.Containers 13. 14. <br /> Total Unit <br /> HM No. Type Quantity Wt/Vol <br /> a. UN1950- AEROSOLS, (EACH NOT EXCEEDING <br /> 1 L CUTAC I TY) , 2. 1, UNIVERSAL WASTE— P <br /> AEROSOLS <br /> b. w9 <br /> S AUG 2 2 2018 <br /> H <br /> I c. <br /> P -- <br /> E <br /> R d. <br /> 15.Special Handling Instruction and Additional Information <br /> SK- SHIP# F25847307 SA23_,_ 4 - <br /> 1)ERG#126• <br /> '4 HR EMEkENCY #1-800-468-1760 (CH / SK / TFI) <br /> AUTH AS "AGENT—FOR" :BY GEN TO RETAIN LICENSED SUP CARRIERS AS NECESSAR <br /> DOT/PRFL A. 79951.20/1.490496 H. C. D. <br /> A) NONE A) C) D) <br /> 16a.US DOT HAZARDOUS MATERIALS SHIP ER'S CERTIFICATION: "This is to certify that the above-named materials are property classified,described,packaged,marked and labeled and are In proper <br /> condition for transportation according to the aoDlicable re Mations of the Department of Trans ortatio <br /> Printed/T ed Name / / Month Day Year <br /> 0. <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: 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 1 Acknowledgement of Receipt of Materials <br /> R <br /> A Printed/Typed Namp Signature Month Day Year <br /> S <br /> P <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R yped Name S nat ) Month Day Yea' <br /> T <br /> R <br /> 19.Discrepancy 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 /> I <br /> I: T <br /> C6 Y Printed/Typed Name 7tre Month Day Year <br /> Lrl r,h M -AL_LL ;_. <br /> 24 HIR EMERGENCY#800-468-1760 <br /> ORIGINAL-RETURN TO GENERATOR FORM NO.01-90291 (03/2015) <br />