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BILL OF LADING/MANIFEST 1•Shipper's US EPA ID No.(if Applicable) Document No, 2.Pagel <br /> - . of <br /> 3-Shipper's Name and Mailing Address W He I 11 V It 3 <br /> 4.Shipper's Phone{ ] <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporter's Phone <br /> S►=iFE T Y-KL.E.EN SYS E>+'fs INC; 1 XR00000,1-20-11 . <br /> 7-Trans iter 2 Com an Name 8- US EPA ID Number B-Transporters Phone <br /> L sSN T K +z7R`a ENV SVC INC. 322250 �8i—�'j'ac: 5000 <br /> 9.Designated Facility Name and Site Address SJ 10. US EPA ID Number G-Facility's Phone <br /> 1&_:.l 13E'-_~t'r'ESSA R00D <br /> SIAIN C1SE CA GAD059494310 406-441-096E'. <br /> . <br /> 11-Shipping Name and Description 12.Containers 13- 14 <br /> Total Unit <br /> HM-I No. Type Quantity WtfVol <br /> a- . (ME] 13ROVE <br /> St rF]t� 3�IL��i) P <br /> I . 570 <br /> b. <br /> S <br /> H <br /> I c. <br /> P <br /> P <br /> E <br /> R d <br /> 15-Special Handling Instruction and Additional Information <br /> SK °'7H 1 P# +::3 4 t.�'-I•::S.P. t t:7 j.l i'{`14 <br /> 4H E.h'E'RS# 800--468,-1'7G;Ci t t:.:H—SK---T F 13 --f RAINS AUT•H TO RE i'A I N AJ)1P w GA RR i.f.RS <br /> A. 4:s =_41.6f6R;e.6971. 6. <br /> A) NONE P) 1-1) D) <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION' "This rs to certify that the above-named materials are properly GaSafied.described.packaged,marked and labeled and are in proper <br /> eondirion for Ira ns onauon ar-cordin to the appllnblo u1a4ons of the Em arlmenl of 7ra SpWation. <br /> PrintedlTyped Name Month Day Year <br /> ■t . <br /> 18b.NON-R LILA ED SHIPPER'S CERTIFICATION: I certify the rnaterials described above on this form are not subject to fed .tions for Transportation or Disposal- <br /> Month Day Year <br /> NINE !i <br /> R17.Trans iter 1 Acknowledge nt of Receipt of Materials <br /> A JP' ted/Typed Name <br /> N Si to Month Day Year <br /> � <br /> P <br /> 0 18-Transporter 2 Acknowledgement of Receipt of Materials <br /> T Printed(Typed Name Si9n re <br /> E Month Day Year <br /> R <br /> 19-Discrepancy I dication Space <br /> F <br /> A <br /> C <br /> I <br /> L 20-Facility Owner or Operator:Certification of receipt of materials covered by this farm except as noted in Item 19. <br /> I <br /> T <br /> Y Printed/Typed Name Sign Month Day Year <br /> MEMi <br /> :11 .i <br /> ORIGINAL-RETURN TO GENERATOR FORM NO.01-90291(03!20151 <br />