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1038 <br />DOCUMENT NO. <br />TRANSPORTER 1 <br />EPA Ill It <br />I*HANSPORTER 2 <br />EPA ID # <br />STrIAIGHT BILI OF LADING <br />WORK ORDER NO <br />VEHICLE ID # <br />Tr.ANS. 1 PHONE <br />VEHICLE ID # <br />TRANS. 2 PHONE <br />DESIGNATED FACILITY <br />SHIPPER <br />FACILITY EPA ID # <br />SHIPPER EPA ID # <br />ADDRESS <br />ADDRESS <br />CITY STATE ZIP <br />CITY STATE ZIP <br />CONTAINERS <br />NO. & SIZE <br />TYPE <br />l --IM <br />DESCRIPTION OF MATERIALS <br />TOTAL <br />QUANTITY <br />UNIT <br />WT/VOL <br />DATE <br />TRANSPORTER 2 <br />A. <br />PRINT <br />SIGN <br />DATE <br />RECEIVED BY <br />B. <br />C. <br />D. <br />E. <br />F. <br />G. <br />H. <br />SPECIAL HANDLING INSTRUCTIONS <br />SHIPPERS CERTIFICATION: This is to certify that the above named materials are properly classified, <br />described, packaged, marked and labeled and are in proper condition for transportation according to <br />the applicable regulations of the Department of Transportation. <br />PRINT <br />SIGN <br />DATE <br />SHIPPER -Iffl DECNERON BERME sir <br />PRINT ;,, ,,.,:,, l <br />SIGN <br />DATE <br />TRANSPORTER -1 <br />PRINT <br />SIGN <br />DATE <br />TRANSPORTER 2 <br />PRINT <br />SIGN <br />DATE <br />RECEIVED BY <br />CHI 107 <br />