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BILL OF LADING/MANIFEST hipper'sUSEPA IDNo.(if Applicable) DocumentN . 2 Paget <br /> or <br /> 3.Shipper's Name and Mailing Address SAN JOAQU I N REGIONAL TRANSIT 1) <br /> PO BOX 201010 <br /> ATTN TRANSIT VISTRICT <br /> STOCKTON <br /> 4.Shipper's Phone( 20'9,-)748-5566 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporters Phone <br /> -XI PFN c c <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transporter's Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number C.Facility's Phone <br /> INC <br /> CA =+454,04 C:Cst)JE' '411993 <br /> 11.Shipping Name and Description 12,Containers13. 14_ <br /> Total Unit <br /> 7HM-1 No. Type Quantity Wt/Vol <br /> a. VERGAIL t4A'3TE LAMP" <br /> It1RE�CF.P1T <br /> LAMPS) <br /> b <br /> S <br /> H <br /> I c. <br /> P <br /> P <br /> E <br /> R J. <br /> 15.Special Handling Instruction and Additional Information <br /> SK ::illi-'# ti'1 31 <br /> P4 HR CMERGENCY #1- 600-468-1760 (1f1FFTY--KLEE.N 94138 <br /> A) NOW <br /> SK ALITHORI7F:n TO RETAIN LICENSE.. S1J75FUL1F:NT Ct`"RPJFRS A5 NE:C'E:SSi'z <br /> K,G'F/P'RF= P, 14815/150604 'S. L. 0. <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: Thish to nary mel t.aduve-ranted matere nale abrobedr eeeeired.de.cnwd.Panee9ad.mewed and leteled and ere m Per <br /> wndiliou or ineggornerna wrdprg bthe a Uadle reaulations or the De enmenl or Tran <br /> Printed/Typed Name Month Day Year <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on all form are not subject to federal regulations for Transportation or Disposal. <br /> •' PtintedrTypeiFName Month Day Year <br /> T 17.TransportevfAcknowledgement of Receipt of Materials <br /> R <br /> A PrintedrTyped Name Signature Month Dayr-„ Year <br /> R <br /> 5 <br /> P <br /> 0 18.Transporter 2 Acknowledgement ipt <br /> ledgeent Of Receof Metal <br /> R Printed/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 <br /> L 20.Facility net or Operator:Certification of receipt of materials covered by this form except as noted in Item 19. <br /> 1 <br /> T <br /> V PrintedrTypad Name Signature Month Day Year <br /> :ll t <br /> GENERATOR'S COPY FORM NO.01-90291(11/09) <br />