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3Shippers US EFA ID Na flf Applicable] Document No- 2_page 1 <br /> . <br /> BILL OF LADING/MANIFEST CPP9P.0iM7.68 7 of "I <br /> 3 Shippers Name and Mailing AddrassT'R.cY' ei.0 E' LO- <br /> ,780l9 Linca'n i'ivenue <br /> fitt-n S&e'�ahanae S£�Slzeiiberu <br /> RIVERSIDE uR 9520ir-0000 <br /> 4.Shippers Phone( 209T,962-48013 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number. " A.Trensperter's.Phone <br /> - - snF£TY"v&EEN" SYSTEMS -INC. TXR88@8S1205.' . . 972-265-212100 <br /> 7-Transporter 2 Company'Name 8. US EPA ID Numbw -__-_ 9.Transporters Phons <br /> '9:Designated Feditme end She Address EVS 1U. . -USEPA ID Numbe, C.Facilltys Phone .. <br /> SAFETY-aEN OF CALIFORNIA, INC. <br /> ---b&&8 SMITH AVE. <br /> 3 : NEWARK CR 94561D CAD980887418 510-795-4400 <br /> 11.Shipping Name and Desoiipliorr 12 C oars Total Unit <br /> - No. Type Quantity WI/Jol <br /> a NONE NON HAZARDOUS NON D:O.T. <br /> REGULATED LIQUIDS t'WATER), N/A TT G <br /> 1 _c. <br /> 000 L) <br /> P <br /> R d 2017 <br /> 15.Special Handling instruction and Additional Information rt <br /> Sty SHIP# 221.622804 CA4�3@-Al�TMENT <br /> Isarppe - — — -- — - -- <br /> 17100 S Harlan Rd <br /> LATHROP CA 35330-9786; <br /> 24 HR EMERGENCY #1-'800-468-1760 tart / TFI) <br /> RUTH AS- "AGENT-FOR" BY SEN TO RETAIN LICENSED SUB CARRIERS AS NECESSRR" <br /> 72897225 <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: msr.m mmtyeuwr uw aw.ram.emaerla4.a PopMytlraAtl.dwabd:prY aH.m.h.a atl lrbaYa.nO era'n mace. <br /> bra e'n nM. o1de0e MTrm m. <br /> datsdaypp"am - - —Mand]- Day Y.er <br /> 16b.NON-REGULATED SNIFFER'S CERTIFICATION: I certry Bre mewna6 tenuilow above on uIs f nn ure not su*d to federal vegWsaa far VtapoMtan orDisplasl. <br /> PrirS@d/Typed ame _ e a y i - _ Martrh D1 0.01 <br /> a Year - <br /> �I�qL �r r Yli, r <br /> en <br /> •..T17.Transporter]Acknowledgementof Recetpt of MatariaLv <br /> R <br /> A nte"ed Name - � ' Sig re Mc 1h Oey Yeer <br /> N �.S <br /> P <br /> o 18.Trains p 2 Aclanowledgement of Receipt- Materials - <br /> R <br /> T FriMed/Typed Name Slgnahae Morar. .DSY Year <br /> E <br /> R. <br /> 19.Discrepancy Imitation SPar_e - <br /> ^F <br /> A <br /> C - <br /> I <br /> _i-.20-Facility Owner or Operator.Certification of receipt of materials coverej by65 farm except is noted In Item 19. <br /> T' <br /> Y ; Pdntedrryped Name Signature Monts pay .Yeer <br /> •rr r <br /> C)AI( 1NIA1:RFTI IRN.Tn2.FhIF.AATAR - FORM NO.01.90291(0312015) <br />