Laserfiche WebLink
SHIPPING 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Shipment Tracking Number <br /> DOCUMENF CAL000401815 1 8775772669 410469260BOL <br /> 5.Generator's Name and Mailing Address Generator's Site Address(rf different than mailing address) <br /> Marshalls #140122 Marshalls#M0122 <br /> 2099527870 2203 Grand Canal 2203 Grand Canal <br /> Generator's Plane: 209952 Stockton, CA 952107 Stockton, CA 95207 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Stericycle Specialty Waste Solutions Inc MNS000110924 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name a6d Site Address Elst Centary EMN, LLC U.S.EPA ID Number <br /> 210% Newlands Dr. East <br /> Fernley, NV 89408 <br /> Facl1' s Phone: 7755752760 NVD9M95338 <br /> 9a. 9b.U.S.DOT Desatption QnGuding Proper Shipping Name,Hazard Class,ID Number,and Padang Group('rf any)) 10.Containers 11.Total 12 Unit <br /> HM No. Type Quantity WLArol. <br /> a <br /> 1-Universal Waste Consumer Electronics for 3 DF 00284 P <br /> Recycling <br /> tr <br /> w <br /> w 2. <br /> 3. <br /> 4. <br /> 13.Special Handling Instructions and Additional Information 1. 102335(Universal E1ectronics) <br /> 14.GENERATOR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and a=ately described above by the proper shipping name,and are classified,packaged,marked and labeledlowarded,and <br /> are in all respects in proper condition for transport according to applicable international and national governmental regulations. <br /> Generator's/Offeror's Printedfryped Name signalixon DenairMonth Day Year <br /> 03 102 018 <br /> i 15.International Shipments <br /> Z ❑Import to U.S. ❑Expwt from U.S. Port of entry/exit: <br /> Transporter Signature for exports on : Date leaving U.S.: <br /> LU 16.Transporter Admowledgment of Receipt of Materials <br /> Transporter 1 PdntedlTyped Name Signature Month Day Year <br /> R Kristopher Almanza 03 102 018 <br /> to <br /> Z Transporter 2 PrinteWyped Name Signatike Month Day Year <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space ou,* Type Residue ❑Partial Rejection ❑Full Rejection <br /> Shipment TrackNumber: <br /> 17b.Alternate Facility(w Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> w 17c.Signature of Aftemate Facility(or Generator) Month Day Year <br /> d <br /> Z <br /> w <br /> 18.Designated Facility Owner or Operator:Certification of receipt of materials covered by the shipping document except as noted in Item 17a <br /> Printeffyped Name ! Signature Month pay Year <br /> r <br /> 169-BLC-0(Rev.5-11) DES TED FACILITY f6GENERATOR <br />