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BiL F LADING/MANIFEST 1.Shipper's US EPA ID No.(If Applicable) Document 2.page 1 <br /> t"Pt 000-3469375 - of <br /> Shippers Name and Mailing Address S -°=!y"; -- Q J,r �,T•1 .:iii:e <br /> St-anford Rd <br /> ..'t 4; <br /> 4.Shippers Phone( i -8 <br /> 5.Transporter 1 Company, 6. US EPA ID Number A.Transporters Phone <br /> UAF"E'TY- l t'N . S YSTRIS INC T-Y,R00,008 U205• 972-265-2000 <br /> 7.Tr rp¢rtprt2 C n ipy�i rr e 8, US EPA Number <br /> 1 t i 1it33'' IV <br /> .1'C.it.i(*r !''+;- i `: t;` � 'r t�ll?TJ ?c 32 F50 <br /> B.TransportersPhon <br /> i <br /> 9.Designated Facility Name and Site Address i% 10. —US EPA ID Number C.Facility's Phone - <br /> Fsl_LAN HARBORS . SPIN ` <br /> a.00-1.1 P=[ fFYI:_8{lA g0AF) <br /> ?Ahs .TtJ^F- f , 9F-,, --._ z • - <br /> tdjd :$.; t ,•;7.:� (>�i�th�'.�94943 i 0A 40S-4 41 <br /> 1 <br /> 11.Shipping Name and Description 12.Cont iners 13. 14. <br /> HM Total Unit <br /> No. Type Quantity wwol <br /> a. LIN2795 BAT-ITRI ES WET FIl % F.D WTTH AI_.KAI..1 . <br /> X 13 f LIN T VRSAL. Wdi_;i I= F°h F'T, h F FS, ' y,- <br /> )i- O F-1 <br /> (Fa FLY f7'F1.{)z� <br /> b. <br /> 3:: <br /> H <br /> C. <br /> P <br /> P <br /> E' <br /> R d <br /> 15.Special Handling Instruction and Additional Information <br /> t.ii^f-I }_gin <br /> 7 1 <br /> , - <br /> g F?i ritj AR)TH 7*0 ?- F `fir'_ TN ADD5 L. 1'ARf TF`,PF3 <br /> f 5) Lif l h-U P0 t"' <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: Rhis Is to certify that the ebove•nemed materiels are py a mad,described,packaged,marked end labeled and are in proper <br /> condition for trahs rtation awdidirf to thea ro licable ula of the De artment of Transportation. <br /> PrInted'ITYPed Name <br /> VE � `�'y ) n Month a e <br /> �L fV <br /> 16b.NON REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above bh this,forrfi sra not subJe t to fe I regulat(ons for Transportation or Disposal. <br /> • Prin,tedayped Name - e. <br /> Month Day Year <br /> T'` 17. <br /> R Transporter 1 Acknowledgement of Receipt of Materials <br /> APrinted/Typed Nam ��� � Signature <br /> S 10 f� l <br /> p:. <br /> o 18.Transporter 2 Acknowledaement of Receipt of Materials ` <br /> ted/Typ9d N <br /> _. <br /> E r Month Day <br /> R to Z <br /> 19.Discrepancy Indication Space01 <br /> F <br /> A` <br /> G <br /> 1 ' 20.Facility Owner or Operator:Certification of r ipt of materials covered by this form except as noted inYtem 19. <br /> 1. <br /> Y' Printed/Typed ame Signature ' th <br /> S11 1 <br /> ORIGINA -`ISE.(UAN"I'O'Gil=(1FERATOR FORM NO.01-90291(0312015) <br />