Laserfiche WebLink
11 �" P.O.Box 80358 • BakmsBeld.CA 93380 • (661)393-1151 <br /> A111111, Aides, <br /> MANIFEST 1.Shipper's Phone r / 2.Page 1 of 3 Emergency Response Phone Man t <br /> „,..dd 3 �r 466.30a J n 0 9 01. M PB <br /> 5.Smpl>eR.9iand AdtltMa AtrSTEVE WDOCSa08dmgsheAdrhesa(hNRerammanmiungaWteeej <br /> ..i.M.�FMPL4T CrMPAN'v J.q.`SIMPLC T COMPANY <br /> 4863 CARPENTER Ri i 7701 S.JACK TQNE RD <br /> STOCKTON -1A. z2t5 STOCK70N L_A, Q5245 <br /> 6.Transporter 1 Company Mug Phone <br /> .2flf:.x -crake's <br /> 7.Iyansporter 2 Company Name <br /> Phone <br /> 8.Designated Facility/Consignee Name and She Address Phone <br /> ApAHYaNA t'votti,. <br /> 10840 Altarypnt mass Ro.>t <br /> l.iv /. <br /> simvr* 9456i, <br /> „ . <br /> 9.SMpphq Nana and Downstage 10.Gatherers <br /> HM tt total 12 Unit <br /> No. Type Ouamay WI.NoI. 13.Notes <br /> 1' ,WA REGULATE[)MATERIAL.INON HAZ+NITER) NC-'NF <br /> CIL 2600 <br /> a a <br /> N 2 <br /> a <br /> MAY 2 7 2ni <br /> a <br /> 14 Special Handling Instructions and Additional Information <br /> Placards Tantlmed? yes_ No <br /> 15 SHIPPEB/OFFEROR'S CERTIFICATION:I Hamby declare that the comems of this consignment are roily and acgulalaty descrlbed she"by top,proper shipping name.and are classdled,packaged, <br /> maraud and Iaheled/placandod,and are to all mspocts;n proper condition for transport according to applicable im_`q\,`'alo're and national government regulations <br /> Snippet/Dilator?: a ame Signatum Month Day year <br /> 18.International Shipments ( <br /> Z I �Intpad to U.S �_J Exporran ILG. Nei I of amry/gxft _ <br /> Transporter signature(for exports only): Dale leaving U.S.. <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Transport ype Namr. Signet r Ir Mann Day ex <br /> a <br /> N <br /> IransporNir2 prinledrTyjad Name St re ai Day year <br /> ti <br /> 18.Discrepancy f <br /> W 18a.Discrepancy Indiwbon Space _ Oummly L-j Type �__�Residue ❑Parhal Rejechon --77 <br /> all <br /> �__.1 full Nnp:r,Lnn <br /> 2 <br /> Manifest Reference Number, <br /> o181H Pressure Facility Phone <br /> TU <br /> 1- <br /> 3 IHr. Sluoamre of Alternate Facility <br /> MomH Day ye:n <br /> V <br /> a <br /> LL <br /> W <br /> H <br /> 9i BIN w'; TRUCK/TRAILER JOB N TICKETo, <br /> 20.Designated Facility/Conslimers Certification of receipt of materials covered by me manifest except as noted in Item 18a <br /> 1 Primed Typed Name Signature Month Day year <br />