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P O.Boz 60358 • Bakersfield,CA 93380 • (661 393-1151 <br /> MANIFEST 1 Shipper's Phone x v 2.Page 1 of 3.Emergency Response PhoneMand sl umber <br /> 5620900 MPB <br /> Slapper s Name and Melling Address — Aoadm <br /> gSRO Address(if diflerentthan mailing address) <br /> 6.Transporter i Company Name Phone <br /> 7.Transporter 2 Company Name Phone <br /> 8 Designated Facility/Consignee Name and Site Address Phone <br /> At1 wra,rn I_a'f!,, <br /> Y.wl i0l:drre:,n. <br /> c, <br /> 9.Shipping Name and Description 10.containers <br /> HM 11.total 12.Una 13.Notes <br /> No Typo Duantiry NMNoI. <br /> a <br /> N 2 a <br /> i <br /> 3. <br /> MAY 2 7 2016 <br /> n <br /> 11, Special Handling Instructions and Additional Information <br /> Placards Tendered? Yes No____ <br /> 15 SHIPPER7OFFEROR'S CERTIFICATION:I bereby declare that the comerds of this consignment are fully and accuraWT described above by the proper shipping name,and are classified,packaged. <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable International and national government regulations. <br /> Shipper/ORamr's NIP ,I / Signature Pip, ,er. <br /> -r 16.International Shipments <br /> 1— D Import to U.S. Port of entry/exit <br /> = Transporter signature(for exports only). Date leaving USr <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporterl jf4�Nama r. ,py �y��;"+e Si Mo <br /> (s( /T �1-/ f! <br /> Transporter 2 Primedrryped Name Signature^ Monty Day Year <br /> T18.Discrepancy <br /> 18a,Discrepancy Indication Space E] Quantity IJ Type l .�Residue ��j Partial Relectton ❑Full Reledton <br /> W <br /> W <br /> Z <br /> 0 Manifest Reference Number: <br /> Z 181.Albertans Facility Phone <br /> O <br /> yU <br /> F <br /> 7 1O.Signature of ARernate Facility Month Day Year <br /> U <br /> Q <br /> LL <br /> W 19. <br /> 2 BIN#'S TRUCK/TRAILER N .108 N TICKET t <br /> Cp <br /> w 20.Designated Fatuity/Consignee:Certification of receipt of materials covered by the manifest except as rated In Item 18a <br /> O Printed-Typed Name Signature Month Day Year <br /> 1 +. <br />