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I <br />ORIGINAL -RETURN TO GENERATOR FORM Na ol-9ml (03mis) <br />BILL --0F LADING/MANIFEST-1Shippers US EPA ID No. (if Appic") boc mleel Page 1 <br />2 :.� <br />.Q./"No. <br />.............. <br />- ¢. <br />3: SNppees Name and MaMwi 'Address'Ve'1't 9" art er"'^J1ap jTl.jt .... .... ...... .. ...__...... .. ......... .. ._.,........,: <br />... .. <br />1173 N Lower Sacrcimento Road <br />LODI CA 95242-'0O0O <br />4. Shippers Phone ( c 09 9J 7—x'306 <br />5. Transporter 1 Company Name 6, US EPA ID Number <br />A, Transporters Phone <br />r—I <br />7. Tranaa�rorrtta 2 C an Name 8. US EPA ID Number <br />CMA& FOWR ORS ENV SVC INC. MAD0393.;?F50 <br />B. Tranrsporter's Phone <br />781-792--5000 <br />9. Designated Facility Name and SNe Address A 18. US EPA ID Number <br />C. Fadlity's Phone <br />CLEAN HARBORS ARAGONITE, L1C <br />1.1600 NORTH APTUS FMAD <br />ARAGONITE UT 84029 UTD961552177 <br />435-884-8100 <br />11. Shipping Name and Description <br />12, C <br />13. <br />14. <br />HM <br />No. <br />Type <br />owlty <br />wNol <br />a' <br />UN1950 AEROSOLS FLAMMABLE N.Q.B <br />F <br />X <br />2-1, LAIVERSAL WASTE- AEROS�IL C�IN(Si <br />� <br />DM <br />l JF� <br />P <br />b. <br />s <br />N <br />1 <br />a <br />P <br />P <br />E <br />R d. <br />15. Special Handing hstmcnon and Additional Irdomk0an <br />SFS SHIP# _234L44914914 DE54200 <br />1)ERG#1s,6• <br />24H <br />EMEROtLNCY#800-468-1760--CH/SK/TFI-Contract retained by generator confer <br />agency authority <br />on initial transporter- to add or substitute additional_tra�sporteSrs an gen <br />atorl s behalf. �f( <br />{{fljr'fjy <br />B. C. D. <br />A_ 9136637/217881D) <br />Al'1.XxN��%y3 <br />NONE B76 <br />16a US DOT HAZARDOUS MATERIALS SHIPPERS CERTIFICATION: 'ra•ae 'ep Mabvwm.we wawuiswp .mwase art uwea..a wr+wope <br />n n. <br />PriMeNTyped Name <br />ow Yw <br />16b.HON-REGULATEDSHIPPERSCERTFICATION: Ic«tdynenwrerL*desaibwabev w#Alamr m4,u' bfedaal regNlbns br irauporlfm aDbpasal. <br />PriMedrryped Name <br />MaM Day Yen <br />N 17. 1 Acker of Receipt of Materials . <br />A <br />s <br />p <br />I Y <br />gyp � Ysar <br />GVi <br />P <br />. <br />1,6111144 <br />0 <br />18. Trams � 2 A4mowledgemetN M {face of Materials <br />T <br />drmedrrYped Name <br />Sig um Nlamh Day Yw <br />E <br />�v z <br />19. Discrepancy Ind"ratlon Space <br />F <br />A <br />C <br />I <br />20. Faddy Owmer or Operalw Cedifica8on of receipt of rratefWs covered by this form except as noted In Item 19. <br />T <br />T <br />ma <br />WOO aw Y <br />ORIGINAL -RETURN TO GENERATOR FORM Na ol-9ml (03mis) <br />