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Q VEOLIA <br /> ENVIRONMENTAL_ SERVICES <br /> SHIPPING 1.Generator ID Number 2.Page 1 of 3-Emergency Response Phone r7iZZ <br /> g Document Tracking Number <br /> DOCUMENT 00797380 <br /> 5.Generator's Name and Mailing Address Genera orsde A dress(if different than mailing address) <br /> "rzRA9'�LA QPXVAX <br /> �--FDEX elf► <br /> &U Imo!WA's <br /> tV AVY,CA 953 <br /> Generator's Phone; <br /> 6.Transporter 1 pang Name <br /> U.S.EPA ID Number <br /> VMJA IS W1INVis1:#3OM"4'E7l? Q 6 3 3 a 9 <br /> 7,Transporter 2 Company Name U.S.EPA ID Number <br /> S.Designated Facility Name and Site Address U.S.EPA ID Number <br /> 1125ROMWSIXP1. <br /> AllmdomFacility's Phone', ��§ 9 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name.Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13,Codes <br /> No. Type Quantity Wt.NoL <br /> ex X 1. MTMIEk Win, <br /> V`r W <br /> OMMUMIL WARTE <br /> W <br /> y 40 <br /> 2. M1lPlm.Sk'irlF.ltllsS, f.7P r�+J7�vrlT� 7�-�.fs !mss�H. <br /> 2010 P <br /> 3 i1Iis141R11.Lt'ww um skiraLwi 9 LENAwmAL wAsut <br /> 4WARTS� wT 1 AMM CXAHV6 pint IBGY'C`3 Rail U9VERSA L NOM <br /> 14.Special Handling Instructions and Additional Information <br /> lbiktu9l i laA¢DY4 1rb! +ht Ot! AL l 1WQ11341W.-?1M0X- <br /> =613 )ERQ 1%W-.45778 A-511A39361 3)FRQ 1+17 W-71 W A_M M111412 4)W-7.1.%3 kAffU1 JQW 2201AI?R <br /> 15. GENERATOR SIOFFEROR S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and Iabeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations. <br /> Generators/0 erors PrinledlTyped Name signature Month Day ear <br /> X <br /> a 16.Intemational Shipments 1:1z Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> Transporter signature for exports only): Date leaving U.S.: <br /> d' 17.Transporter Acknowledgment of Receipt o1 Shipment <br /> Lu <br /> Transporter 1 PnnledlTyped Name gnatureMonth Ljay Year <br /> a <br /> ZTransporter2 Printedi7yped Name Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Shipping Document Tra&ng Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br />' J <br /> U <br />• a <br /> Facility's Phone: <br /> U jj 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> H <br /> a <br /> z <br /> y19.Report Management Method Codes(i.e.,codes for treatment,disposal.and recycling systems) <br /> in 1- 2. 3, 4 <br /> 20.Designated Facility Owner or Operator,Certification of receipt of shipment except as noted in item 18a <br /> PrinledlTyped Name Signature Month Day Year <br /> GENERATOR 1 SHIPPER'S INITIAL COPY <br />