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wIF,V""=7VV` Y <br /> F <br /> 1 <br /> 1 , Shipper's US EPA ID No. ( If Applicable) Document No. 2. Page 1 <br /> BILL OF LADING/MANIFEST « rK i I of <br /> Fr <br /> 3. Shipper'sName and Mailing Address `31.= 1tui •f # � _Ar t ­1A LFItt ?zr <br /> CV <br /> 4. Shipper's Phone ( 1 ' f ) ` � +.g " ' . a QWV$ 4 <br /> 5. Transporter 1 Company Name 6, US EPA ID Number A. Tran sporter's Phone <br /> t # N s ; ai ( 11 x t y`<tl".: f. 1 VIA r1 t .VI <br /> 7. Transporter 2 Company Name 8, US EPA ID Number B . Transporter's Phone <br /> 6 ur <br /> j # . tfi kA ,, , � f. ; # # e :° ° ftp <br /> 9. Designated Facility Name and <br /> 44 Site Address q ril ( `) 10. US EPA ID Number C. Facility's Phone I(. <br /> �.' t✓ # � � . # � (` # f.' � f tr � E # r .: , S �k ¢:"3 � .t F�'� t .� n t <br /> "S r <br /> i #t, dti iIr ` # t r a . <. <br /> 11 . Shipping Name and Description 12 , Containers 13. 14 , <br /> Total Unit <br /> HM No. Type Quantity WWol <br /> a . €., i )i ,; i ' i .r ' .1a i S t E p ; r¢. i R 9 .3 $ („# °. IM , 4 ( fie . d.: ) .iI „ 4 t # `, #''a <br /> D r $ <br /> b � _ I <br /> S, u <br /> H <br /> c, <br /> P (; <br /> P <br /> E <br /> I' <br /> R d. <br /> 14 <br /> n. <br /> 15. Special Handling Instruction and Additional Information <br /> 5 ` " ` " ° <br /> � If: i <br /> 3i t#. °s ;€ { t r .,mss..: ,& st$= jr:7r `` . ! ,. $ rt . ,.`. ! <br /> r <br /> ( ) tr ) r; . 2 } ' _ ` `h l FIII ,VT $. Tcul # tow : ( ? tt � ) # � _ )� � _ ( ; ? . £ `# � 6� �,f C: �`) � � ( ` �' tU <br /> FF <br /> _I <br /> & _ > ”", � � ° ;1 .r j #' r <br /> 6" #` E f ' <br /> f <br /> VV VVI <br /> l <br /> S DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION : 'This is to cerfify that the above-named materials are properly classified, described, packaged, marked and labeled and are in proper <br /> 16a. U condition for transurtation accordm to the applicable regulations of the Department of Transportation. <br /> PrintedrTyped Name Month Day Year <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 /> Priritedrryped Name g , Month Day Year <br /> r <br /> � . <br /> « <br /> 17 Transporter 1 Acknowledgement of Receipt ofM � � r �� � � # �� . a.� ( ��• <br /> _ ! <br /> T p g ecei f Materials <br /> R <br /> A Printed/Typed NameSignature ', Month Day Year <br /> N <br /> FIV JL4 <br /> 1 <br /> g ! p s <br /> F <br /> rf <br /> III <br /> P 1 ,_ . w . <br /> 7771 <br /> 0 18 . Transporter 2 Acknowledgement of Receipt of Materials <br /> T IIIIIIFFFIFIII <br /> PrintedrTyped Name Signature Month Day Year I <br /> E <br /> R <br /> 19 . Discrepancy Indication Space <br /> D <br /> F <br /> A <br /> C <br /> I <br /> I3 <br /> L 20 . Facility Owner or Operator: Certification of receipt of materials covered by this form except as noted in Item 19. <br /> T <br /> Y Printed/Typed Name Signature Month Day Year <br /> I! <br /> FORM NO. 01 -90291 (03/2015) <br /> G � E �ATG � � � G �� � <br />