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BILL OF LADING/MANIFEST 71.Shippers US EPA ID No.(if Applicable) Document 11IR!"' 2.Page I <br /> b�,Ifi li. -, 5093 . . . of <br /> 3.Shippers Name and Mailing Addressf�AN JOM21jIN R4 <br /> i P 0 Pox 20 1 0 1 Q!, <br /> 4.Shippers Ph oi <br /> S.Transporter 1 Company Name 6. US EPA ID Number <br /> A.Transporters Phone <br /> GAr.F I y- sy,51 M% 1 Nr,,, I—T X <br /> uea: <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transporters Phone <br /> 9.Designated Facility Name and Site Address 1 324 1 10., US EPA ID Number C.Facility's Phone j! <br /> Aii-R17". COml t.W, <br /> 3077 HUN'iw(.10r) AvF" <br /> HAYWARD CA 45,44 <br /> UP D98P4 119 93 510--4,,o9 -1129 <br /> 11.Shipping Name and Description 12.Cori them 13. "it <br /> Wttvol <br /> HM Total <br /> a. 'NI VERSAL WASI E L AMP No. Type Quantity un <br /> (FL.LJORESrF' LAM; <br /> F <br /> b. 176A 1 32 PCS <br /> HRO X <br /> P <br /> P 5 3--1 Pii <br /> R <br /> E <br /> d. <br /> 15.Special Handling Instruction and Additional Information <br /> L <br /> 1`"533 E LANDSAY Sr �7,HIP# 204941­�39C <br /> ATTN IRPNSIT DISTRICT <br /> 51-OCKI'ON C'n 9,saoi-i <br /> 24 HiRl EMERBENCY #3 -81210-46,6- 3760 (SAFt--TY--KLEEIq -ON,TFmCT <br /> SK AUTHORIZED TO RETAIN LTCENSED SUBSEQUFNT CARRH-�R'S AS NECESSARY <br /> D0T/PF?FL A. 14815/1502211 f% C. D. <br /> A) NONE Ek) I,) 1)t <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: I.to-ni,1W lbo iieii—amd it"Wd�',&ftd�=nPo" "d is ad hisited abq am in mpw <br /> n �:7 <br /> ,v, in <br /> tion to bans a I d to the aWh Traria tt=a <br /> Printed/Typed Name Month Day Year <br /> am <br /> 16b.NON-REGULATED SHIPPERS CERTIFICATION: I certify the materials described above on this torn are not subject to federal regulations for Transportation or Disposal. <br /> Printed rRed anneP, V -1�� � gn5, Ilay, yea, <br /> I ) <br /> R 17.Tran46rter 1 Ackrfowle6gement of Receipt of M rials <br /> A Printed S tu <br /> N ii <br /> 5 Month Day Year <br /> 1221131 <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Matehals <br /> It <br /> T Printedrryped Name Signature MIn Day Yea, <br /> ER an <br /> 19,Discrepancy Indication Spam <br /> F <br /> A <br /> C <br /> I <br /> L 20.Facility Owner or Operator:Certification of receipt of materials covered by this form except as noted in Item 19, <br /> 1 <br /> T <br /> V Printed/Typed Name Signature Month Day Year <br /> wlw�M <br /> GENERATORS COPY FORM NO.01-90291(11109) <br />