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SHIPPING UI-000393335 <br /> enerator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Shipment Tracking Number <br /> DOCUMENT 1 1877-577-2669 415141860BOL <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> O' Reilly Auto Parts#3610 <br /> 417874757 1551 WEST MAIN STREET 1551 WEST MAIN STREET <br /> Generator's Phone'+I?8 74 R I PON CA 95566-3012 RIPON, CA 95366--3012 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Stericycle Specialty Waste Solutions Inc MNS000110924 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address 21 5t Century Environmental Of CA U.S.EPA ID Number <br /> 11855 White Rock Road <br /> Rancho Cordova, CA 95740 <br /> Facility's Phone: CAR112111211021 <br /> 9a, 10.Containers 11.Total 12.Unit <br /> HM 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number,and Packing Group(if any)) <br /> No. Type Quantity Wt.Nol. <br /> i <br /> o �atterie5, Dry, Sealed, N. U. S. (Alkaline) , Not 1 CF 00002 R <br /> 4P Subject to the HMR (UW Batteries) <br /> w <br /> z 2 <br /> w <br /> c� <br /> 3. <br /> 4. <br /> 13.Special Handling Instructions and Additional Information <br /> 1. 100664(Universal Alkaline Batteries) <br /> 14.GENERATOR'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,marked and labeled/placarded.and <br /> are in all respects in proper condition for transport according to applicable international and national governmental regulations. <br /> Generat 's/Off ror's Pr"edfryped Name Signature A Month Day Year <br /> V .11,9311101— 1 08 123 c_19 <br /> -i rerltioniffShipris Import o U.S. Export from U.S. Port of entry/exit: <br /> r Si nature exports only): Date leaving U.S.: <br /> cc 1 .Tran orter Acknowle of Materials <br /> w <br /> Transporter 1 Printedrryped Name Signature Month Day Year <br /> Jared Marcie1 08 123 2W9 <br /> Z Transporter Printed/Typed Name Signa re Month Day Year <br /> cc ► <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space <br /> ❑Quantity ❑Type El Residue ❑Partial Rejection El Full Rejection <br /> Shipment Tracking Number: <br /> F 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> fJ <br /> LL Facility's Phone: <br /> w 17c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> C7 <br /> w <br /> W <br /> O <br /> 18.Designated Facility Owner or Operator:Certification of receipt of materials covered by the shipping document except as noted in Item 17a <br /> Printed/Typed Name Signature Month Day Year <br /> S ( L ry <br /> \169-BLC-0(Rev.5-11) DESIGNATED FACILITY TO GENERATOR <br />