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481029=1 $ II I1111I I111111111I1111I I I II Ill <br /> 481029-18 3403945-001 <br /> Bill of lading Number Date of Pitkup • *_ <br /> BILL LADING <br /> 481 D29029=1 8 Pagel of 12 5 18 2 <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 Codes <br /> No. Typo/Size Quantity Wt.Noi. <br /> UNIVERSAL WASTE• ELECTRONIC DEVICE(S) (GENERAL E-WASTE) <br /> � 1 CW 350 P <br /> J1Ni 044 BAE.MNGUISHF9S.Wi <br /> ' ! / <br /> X .0 <br /> UNtQ.fiQ.MET1iYLAG6TY�ENEANDPROi+ADIENENiFx-1:FiRL�E�-sTABI1.uEo3e1-- - <br /> 4. UN1978 PETROLEUM GASE% LIQUEFIED 2.1 <br /> )( 1 OF 5 P <br /> Additional Information/Lab Code <br /> (1) OSHEWASTE-OT - ERGO) OSHEWASTEwD7 - E-WASTE (2pOSHFIRE06YERG(•128)�OSHFIRE&06 RPPMG' MAPPOGASOYMNDERS (4) <br /> •OSHPROPANE•O7 - ERG(115) OSHPROPANE•07 - PROPANE CYLINDERS <br /> C ' <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 Date <br /> Tractor # y Trailer # " ' Box Spotted # Box Picked Up r - �� 1.1ner <br /> Transporter #1 <br /> NAME STERICYCLE SPECIALTY WASTE SOLUTIONS INC Phone <br /> rEPA lD NO. MNS000110924 <br /> Print Name Chris Gilliam 2( w-• Date 12 5 18 <br /> Transporter #2 �'✓ <br /> NAME _ Phone <br /> EPA 1D NO. <br /> Print Name ! : Date <br /> TSDf Arrival Time _ _ Reason for Delay E4 TSDF Departure Time <br /> Delay Time <br /> Finish Time - <br /> Contact Broker <br /> CosigneefrreamenUStorage/Disposal Facility EPA Identification Code No. CAD980884183 <br /> Cosigned To : GENERAL ENVIRONMENTAL MGT LLC DBA PSC ENVIRONMENTAL SERVICES V 1 Fri 014• ° ' Z t '` <br /> 11855 WHITE: ROCK ROAD, <br /> RANCHO CORDOVA CA 95742 (916) 351 =0980 <br /> This is to Certify the acceptance of this waste for treatment storage disposal <br /> Print Name MIMDate <br /> s - i � MUM <br />