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L OF LADING/MANIFEST 1.Shipper's US EPA ID No.(If Applicable) Document No. 2 Page:1 <br /> 41 CaA{��l.00 346875, S", a of <br /> 3.Shipper's Name and Mailing Address 9 boldt211 s3 -G <br /> 14501• Wes-It 4StaTifard Rd <br /> Attn SAMutal hkchenry <br /> TRACY 13A 95377 <br /> 4.Shipper's Phone( "� ' +`�• �`t <br /> 5.Transporter 1 Com" qy`" me 6. US EPA ID Number A.Transporter's Phone <br /> S'AEETY�=-R E,LEN ,r,1� TEM,-� ]:NC 7 Y,•R4 00081c�t� <br /> 97Z*: 63---�:rr 00 <br /> 7 ? � <br /> ENVIRONMENTAL G V 8, T NC e IvO(�T�4�1!3932e ~150 B.Transporter's Ph one 1 <br /> 9.Designated Facility Name and Site Address E L 10. US EPA 1D Number � C.Facility's Phone <br /> DORADO' ,LLC <br /> E� ICA C'IF 'LE <br /> EL DORADO AR 71730 ART.)069 74th 1`fir:' <br /> 11.Shipping Name and Description 12.Cont iners 13. 14. <br /> HM No. Type Quantity al Wt/VoI <br /> a. !N 19,90 AERCI;�OL � f`lON--Fl._I`�lVih�tE'��LIT (EACH H <br /> b. K NOT F Xt�,'EED I NG 1 L CAPACITY) , "'. �: .-F11 <br /> a <br /> ldo f <br /> V <br /> S <br /> H <br /> c. <br /> P <br /> P <br /> E <br /> R d <br /> 15.Special Handling Instruction and Additional Information <br /> ADESA -- Golden (1i.it fs SK SHTP# 224547795' A1)F,01")F1 <br /> 1,8501 Stamford Rd <br /> Atte Safety 5r�m <br /> TRAC: CA 95,237.7-9708 C D 7 . <br /> 1)F R[G 24 <br /> AUTi-;FlAS'1_ G-ENCYMNt-FDR"' BYpGEN-vT'O RETAIN LICENSED T SUB CARRTERS AS NF"Cric:S'SARY <br /> DOT/PRFEL; Ao 764M500/1027285 B- C. De <br /> A) 343 R) G) 1)) <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: 'This Is to ce tify}hat the above-named and l <br /> k <br /> , ed lend or In grope <br /> materials are properly classified,descri d ka dmarabeed e <br /> condition for frena rledon accord) to thea itcable re uletbns of the De art nt T ns marked <br /> Printed/Typed Name/► <br /> Month Day Year <br /> l: F+ V a• i 7nAti <br /> 16b.NON-REGULATED SHIPPER'S CER IFICATION: I certify the materials described above on this form are not subject to federal regulations for Transportation or Disposal. <br /> •' Printed/Typed Name <br /> Month Day Year - <br /> R17.Transporter 1 Acknowledgement of Receipt of Materials <br /> S rintedlf Naris. Signa <br /> N Month Da Year <br /> P y <br /> O 18.7ransporter 2 Acknowledgement of RecelDt of Materials <br /> R <br /> T P, ped Name c Sig 't re <br /> E j <br /> R Month Day Year <br /> � �/ <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 /> 1 <br /> T <br /> Y Printed/Typed Name !. <br /> Signature Month Day Year <br /> :111111.151 <br /> ORIAIMAI _R;Z*1 1IRM T(1 rFAIGRATno n FnPhA nln n•k_onooi 16111)n,19" <br />