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- P U.Box 80358 • Bekers8eld,CA 93380 • (8611393-1151 <br /> MANIFEST Shipper's Phone a • 2.Pape t of 3 Emergency Response Phone Manu n r <br /> C A L L+ G 3 k �, ; 2 1 �1 BlZ��583036OH99 MPB <br /> 5 Shdpne's Name and Mailing Address AT $i�'JE WOOO�'aeding Site Address 01 different than mailing admossl <br /> J.R.SIMPLOT COMPANY JR.SIMPLCT COMPANY4883 CARPENTER RD 7787 S.JACK TONE RD <br /> STOC'.KTON CA 95215 STOCKTON CA 952155 <br /> 6.'franspor ter 1 C,mpany,Name Phone <br /> MP Environmental Services � C A T O IJ 0 6 2 4 2 4 7 <br /> 7 Transporter 2 Company Name Plane <br /> fl.l! ..,rod tine ArlNec`' Phare <br /> HC'cr^nPi .ail <br /> 10840 Altamont Pass Row <br /> Livem-fore CA 94551 <br /> n a a 3 R 9 7 . <br /> 9.Shipping Name and Dasenpbon 10.Containers <br /> HM 11.Total 12.Unit f3 Notes <br /> No. Type Quality wtNol. <br /> 1 NON REGULATED MATERIAL(NON HAZ VATER) <br /> w NONE <br /> a p p 1 T G <br /> r <br /> MAY 272016 <br /> 4 - . nrx.MiMlr <br /> la Special Handling Instructions and Additional Information 1)PROFILE#828499CA,CONTAINMENT tAF,TER. WEAR PROPER PPE <br /> Placards Tendered? yesNo <br /> 15 EINFPEIt1OFFEpBB'8 WITIFICAT18N,I hereby declare mat the contents m this consignment are fully anti accurately above by the proper shipping name,and are clip silled.packaged <br /> marked and IabehaVplacarded,and are In all respects in proper Carolina,for transport according In ineducable imem al anti aboral govemmem regulations. <br /> Shipper/OBeror's Pd ed Namo Signal Mona Day Y,,v <br /> 18.International Shipments I� <br /> 1- ❑Input to U.S, Export Iran ll.S Port of enby/8fm <br /> — Tanspm ler signature(lpr exports only): hate Inawnp U.S <br /> W17.Transporter Acknowledgment of Receipt of Materials <br /> 0 inns e ;i ecUTyped Name 310 1 Month Day mar <br /> a <br /> N <br /> Tra spn ter .PfingedTyped'Nallif Austere yglinth Uay Year <br /> F <br /> 18.Discrepancy f �I <br /> 18a Iliscropancy IntllcaWn Space n Quantity 1 type ❑Residue LJ Partial Re action �t <br /> w I CJ Full Rejectron <br /> 2 <br /> rn Manifest Reference Number. <br /> Z 1 AbAllernala Facility Phone <br /> O <br /> F>U- <br /> .r 18r. Signature of Aaernate Faculty <br /> u Month pay year <br /> Q <br /> W 19. <br /> z7 BIN a S ._„ !RUCK/TRAILER# _/____ JOB#_ TICKET a __ <br /> 05 <br /> CW20 Designated Facility i ConsigneeCertification of racerpt of matenals covered by the nardest except as noted In gem 18a <br /> O Photon Typed Name Signature Month Day War <br />