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I 3w <br /> BILL OF LADING/MANIFEST�7' Shippers US EPA ID No.(if Applii Document No. 2.Page I <br /> (If I 1.)94:4 C,--/I-,0;53 Of <br /> 3.Shippers Name and Mailing Address!5�4N III U <br /> PC BOX CIQII030 <br /> STOU0-ON <br /> 4.Shippers Phone <br /> S.Transporter 1 Company Name 6. US EPA ID Number A.Transporters Phone <br /> SYSTEMS, INC. TX-R00j00sevJ,.--w 9'7 11 20 0 01 <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transporters Phone <br /> 9.Designated Facility Name and Site Address 7/401 10. US EPA ID Number C.Facility's Phone <br /> SAF <br /> SYS'Ri INC <br /> DIFNTON, rx <br /> 7 ra 2 0 a 940-463-5al(DO <br /> 11.Shipping Name and Description 12.Cori iners, 13. It,4 <br /> --J Ui <br /> HM Total Unit <br /> W Vol <br /> WT1fJ No. Type Quantity wwof <br /> a. :Y WFi F .1.LL.E.D Al,KAL.I <br /> 012795 PIG III <br /> UN7YERSAL, WASTE') <br /> th <br /> asi <br /> S <br /> H <br /> P <br /> P <br /> E <br /> R d. <br /> 15.Special Handling Instruction and Additional Information <br /> 1533 F i-Ili -Si 17 7 1 1 Ell <br /> ATTle4 1RANS11 DISINICI <br /> SrfJ(.'KJ`0N CA C35POLO, <br /> 2.4 HR EMERGENCY #1. 4?00-468-1760 SAFF r Y--KLEEN CONTRACT #34138) <br /> SK AUTH" D TO USE SlUbBROIJENT C,'$)RF�IFRSi4lO78, 41471, 816F.il, 82739, 8,';39g <br /> ()OT/VjRFL n' 1100004C-11c12.50 D. C. [I. <br /> I-0 f,0,1-r9,30'114 6) f.,) 0) <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: W Oini suit the.10ro-Iarri neteral...Protein,detwited.d-iosed.to.aii retrued and soated rid li ani <br /> on for trans ratan ai to mea pplisoattio nindawns of the De neem Of Thirii,nriatii <br /> Printed/Typed Name Month Day Year <br /> 44 1-9 L14 <br /> 16b.NO LAT SHIPPeIk'S CERTIFICATION: I certify the materials described above On this form are not subject to f6cithal'nagulations for Transportation or Disposal. <br /> Printecirryped Nanire Month Day Year <br /> T 17.Transporter I Acknowledgement of Receipt of Materials <br /> It <br /> A Printed/Typed N Sigi tbc I e Month 0 Year <br /> N NY <br /> S 1C) It <br /> in <br /> Day <br /> y 'Yea' <br /> Year <br /> -Y Year <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R <br /> T Printed/Typed Name Signature Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L 20.Facility Cwn.r or Operator:Certification of receipt of materials covered by this form except as noted in Item 19. <br /> I <br /> T <br /> y Printed/Typed Name Signature Month Day year <br /> GENERATOR'S COPY FORM NO.01-90291(11109) <br />