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481029-18 481029-18 3403945-001 <br /> Bill of Ladin Number Date of Pit uV-- <br /> 481029-18 BILL OF LADING Page 1 of 2F— 12 5 18 <br /> Emergency Phone# (877)577-2669 <br /> Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> ORCHARD SUPPLY#1570 ORCHARD SUPPLY#1570 <br /> 2650 N MAC ARTHUR DR. 2650 N MAC ARTHUR DR. <br /> TRACY,CA 95376(209)662-0192 TRACY,CA 95376 2096620192 <br /> HM US DOT Description(Including Proper Shipping Name,Hazard Class and ID number) Containers Total Unit State Waste CodesNo. Type/Size Quantity Wt./Vol. <br /> UNIVERSAL WASTE-ELECTRONIC DEVICE(S)(GENERAL E-WASTE) <br /> 1. <br /> 1 C W 350 P <br /> I IN1 naa FIS=_ • HGAS 9 9 <br /> 4. UN1978 PETROLEUM GASES,LIQUEFIED 2.1 <br /> X 1 DF 5 P <br /> Additional Information/Lab Code <br /> (1)OSHEWASTE-07-ERGO OSHEWASTE-07-E-WAST QFaS(4) <br /> -OSHPROPANE-07-ERG(115)OSHPROPANE-07-PROPANE CYLINDERS <br /> Contract/PO No. Special Instructions/Reasons for Delay <br /> No.of Overpacks used <br /> Start Time <br /> Arrival at Customer <br /> Departed Customer <br /> Delay Time <br /> GENERATOR CERTIFICATION <br /> "I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and classified,packaged,marked and <br /> labelled/placarded,and are in all respects in proper condition for transport according to applicable ternational and national governmental regulations."I also certify that all <br /> times listed above are true and correct. <br /> Print Name ' I ` Date <br /> Tractor# Trailer# Box Spotted# Box Picked Up# Liner <br /> Transporter#1 <br /> NAME STERICYCLE SPECIALTY WASTE SOLUTIONS INC Phone <br /> EPA ID NO. MNS000110924 <br /> Print Name Chris Gilliam Date 12 5 18 <br /> Transporter#2 <br /> NAME Phone <br /> EPA ID NO. <br /> Print Name Date <br /> TSDF Arrival Time _ Reason for Delay <br /> TSDF Departure Time <br /> Delay Time <br /> Finish Time <br /> Contact Broker <br /> Cosignee/Treament/Storage/Disposal Facility EPA Identification Code No. CAD980884183 <br /> Cosigned To: GENERAL ENVIRONMENTAL MGT LLC DBA PSC ENVIRONMENTAL SERVICES <br /> 11855 WHITE ROCK ROAD, <br /> RANCHO CORDOVA CA 95742 (916)351-0980 <br /> This is to Certify the acceptance of th- e for tjeament storage disposal <br /> Print Name (� o Date �� � � <br />