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1.Shipper's US EPA ID No.(If Applicable) Locumentitill 2.Page 1 <br /> i BILL OF LADING/MANIFEST .� of <br /> 3.Shipper's Name and Mailing Address McLane Food Service <br />+I 800 E'� Pesca dera five <br /> TRACY CA `115;:3V14_..0i 010 <br /> 4.Shipper's Phone( 20 9)"'�.�•.F.�.""'7,.]V3 <br /> 5 Transporter 1 Company Name 6. US EPA ID Number A.Transporter's Phone <br />! S APETV--bpi-E EN S ISI _ E -a- rte,. Kirn0_r, .q-.- rA419I <br /> I 7.Transporter 2 Company Name 8. US EPA ID Number B.Transporter's Phone <br /> E Lr AN HARBORS ENV SVC INC. MfID039 3t:'.2250 <br /> 9.Designated Facility Name and Site Address C3 T 10. US EPA ID Number C.Facility's Phone <br /> CLE AN HARBORS ,Ear's ,fir. SE <br /> 1021 BERRYESSA ROAD <br />' BAN JOSE ("A 95t7-413 CA13t7 594943 i Z 408-441-0962 <br /> 11.Shipping Name and Description 12.Containers 13. 14. <br /> Total Unit <br /> HM No. Type Quantity Wt/Vol <br /> I a. LIN2,79 BATTE_R I E.G WE=:"r FI( LED WITH ALKALI, <br /> X <br /> F3 (UN z�—r1£.3AL WASTES BhTTE R I E S) <br /> (ER6#154)4) p.C3 0 6-01 <br /> b. UN1VE'RSAL WA STE• LAMPS <br /> (FLUORESCENT LAMPS) CF o � �r <br /> C. <br /> i P <br /> P <br /> E <br /> R d. <br /> 15.Special Handling Instruction and Additional Information 2`'�• k(J` (, <br /> 1 )[--RC•;#154 <br /> k 241! E":MER0 800-468-1760 (CH-SK--TF1) --TR ANG AUTH TO RETAIN 911DI "' L CARRIERS' <br /> I <br /> ))0_r/PRFL A,. C7C'9.i.559''' 1�14��:f08 B. 14815/150228 C. D. <br /> (1) NONE: F.4) NONE C) ID) <br /> I <br /> I <br /> i 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: "This is to�:vrhy that Iheabovo-ruvrrod matnrWlisrb prepa"classif ed,dMrbao pbihagad,mRrkad uta iaiaalod arta are v,proper <br /> obrWiimM lar lrammrla P"OrdIng tD 1n0 o iant"ro atrd,ana of Ino 013110MITION of Tr alfon. <br /> PflntedName Month Day Year <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on this form are not subject to Aral r lations for Transporfxtlon or Disposal, <br /> ' Printed/Typed Name Month Day Year <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials /• <br /> R <br /> APtintedtT ped Name Signature f' r Month Day Year <br /> r r !ff f r7 <br /> o 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printed/Typed ed Name S�rtature <br /> T yp Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> 20 Facility Owner or Operator:Certification of receipt of materials covered by this form except as noted in Item 19. <br /> T <br /> Y Printedrl-yped Name Signature Month Day Year <br /> I <br /> GENERATOR'S COPY FORM N0.01-90291 (03/2015) <br />