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PO.Brix 80358 • Bakersfield,CA 93380 (661)393-1151 <br /> MANIFEST 1 Shipper's Phone# 2 Page 1 of 3 Emergency Q Response Phone Man MPB <br /> 5,Shipper's Name and Mailing Address Alt Cry^.,:; loading Site Address(if different than mailing address) <br /> 6 Transporter 1 Company Name Phone <br /> 1.Transporter 2 Company Name Phone <br /> 8 Designated Facllty/Consignee Name and She Address Phone <br /> i7airy..yr;r'� 3r•�f� <br /> W <br /> HM 9 Shipping Name and DescriDeon IO Contamads11 Totalu 12 Unit <br /> No Type Quantity MAN. 13.Notes <br /> 11'li'1 <br /> W <br /> a <br /> a <br /> = 2 _ <br /> N <br /> 3. AY 2 7 2016 <br /> 4, <br /> 14. Special Handling Instructions and Additional Inlormahnn .. .... .. _. . . -... .. . ._.,, <br /> .. .. ... .. ;I^r PIPE <br /> Placards Tendered? Yes__ No <br /> 15. 3RIPPERrOFFEROR'S CERTIFICATION'I hereby declare that the contents of this consignment am Why and secondary described above by the proper shipping name,and are classhkd,packaged <br /> marked and Iabeled/Macarded.and are in all respects In proper condhion for transport according M applicable international and national government regulallons. <br /> • r <br /> Shlpper/Offemi 5 Plowy0e,614ame Signature Month Day Year <br /> 16.1Td0rnatlonal Shipments Ll Import to U S. ❑Export from U.S Port of entry/edt <br /> Transporter signature(tor exports only) Date leaving U.S.' <br /> 17.Transporter Acknowledgment of Receipt M Materials <br /> Transporter 1Pont d NafM ♦ �I signature C 1' ,r— - ' M D year <br /> N S/ <br /> Transporter Pdntea/ryped Name Signature Month Day Year <br /> 1 <br /> 18,Discrepancy <br /> 18a Discrepancy Indication Space ❑ <br /> Quantityy1 PoPe Residue Partial Rejection <br /> Full Rejection <br /> Manliest Reference Number: <br /> Z 18b.Alternate Facility Phone <br /> O <br /> U <br /> 1 Bc.Signature of Ahemale Facility Month Day Year <br /> V <br /> d <br /> LL <br /> 19. <br /> = BIN N'5 - TRUCK/TRAILER; _. ,ION#._ TICKET#_ <br /> uu 20.Designated Facility/Consignee Certificated o1 receipt of materials covered by the manliest except as noted in hem 1 Be <br /> Ptlnlad,'Fyped Name Signature Month Day Year <br />