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BILL OFFADINGWANIF :ST 1.Shipper's US EPA ID No.(If Applicab 2.Page 1 <br /> E —1 Of <br /> 3.Shipper's Name and Mailing Address E3anfs <br /> .Auin Repional T'ransit <br /> 2849 E yrt 1.e -it <br /> STOCKION CA <br /> 4.Shippers Phone( <br /> j4, <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporter's Phone <br /> 9;4 <br /> S464: -046, -k <br /> 7.fi;in's-po-riteir 2'Company Name &- 8. US EPA ID Number B.Transporters Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number C.Facility's Phone <br /> ,jj <br /> CL-E.AN HARBORS SAN JOSE <br /> Mt BJ�RRYESSA ROAD <br /> SAN JOSE CA 95133 CAD059-49431 0 408-441 ---09&'�', <br /> . . . . . . . . . . . <br /> 11.Shipping Name and Description 12.Conte iners 13. 14. <br /> F -1 Tote! Unit <br /> —HM No. Type Quantity Wwoll <br /> a. UN1930 AE-ROSOUS, (EACH NOT EXCEEDING r <br /> X I L CANWITY) 9 2- 1, UNIVERSAL WhSt-E- <br /> Afi.R09(3LS <br /> b. <br /> UN,3.I2K."8 BATTER 11-E3 I. CONI-AWNG <br /> S X PDTA§81LJM HYIMME SOL.-IT) ELECTRIC P <br /> H 13MDRABE, ,. 8, (UNIVERSAL WA&TE) <br /> I C. <br /> P <br /> P <br /> E <br /> R d. <br /> 15.Special Handling Instruction and Additional Information <br /> 1.)ERG#12Fjo2)ERG#154 <br /> 24 HR A00 'SK S HIP# SA35289 <br /> EMEAGENCY #1 -468-1.760 (SK T*FQ <br /> AUTH AS "AGENT-FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECEISSARY <br /> DOT/PRFL.- f*)I. 7789636/1205*92 B. -17f.W151/ 120,3067 C. D. <br /> 0) NONE B) NONE C) D) <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: This is to certify that the above-named materials are property classified,described,packaged,marked and labeled and are In proper <br /> -ndlliw for trans applicable repulallons of the Department of Transportation. <br /> Printed/Typed Name Month Day Year <br /> ,( j-), A-1— <br /> X., o WL-1 " �, �4'--10 <br /> 16b.NOWRIMULATED§HIPPER S CERTIFICATION: I certify the materials desvibed above on this form are not subject to federal regulations for Transportation or Disposal. <br /> Printed/Typed Name Month Day Year <br /> 11111174M <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> A PHhted/-ryped Name Signature,,'— <br /> N Month Day Year <br /> S <br /> ( <br /> P <br /> 0 18.Transporte 2 Acknowledgement of Receipt of Materials <br /> R <br /> T Printed ed Name Signature Month Day Year <br /> E <br /> R I <br /> 19.Discrepancy Indication Space <br /> IF <br /> A <br /> C <br /> REQEN <br /> I <br /> L 20.Facility Owner or Operator:Certification of receipt of materials covered by this form except as noted in Item 19. OCT 2 4 2016 <br /> 1 <br /> T <br /> Y Printed/Typed Name Signature Month Day Year <br /> ENVIRONMENTAL.HEALTr <br /> GENERATOR'S COPY FORM NO.01-90291(03/2015) <br />