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Nov 0,8 11 12:15p AOL AOL p.11 <br /> BILL OF LADING/MANIFEST 1'�ppersUSEPA IDNo.[If Applicable) Document No. 2Page1 <br /> of <br /> 3.Shipper's Name and Mailing Address=]i:� ' >'�• '•` ... 't — <br /> z ; <br /> 4.Shipper's Phones( � •) ' <br /> 5.Transporter 1 Company Name 8. LIS EPA 10 Number A.Transporter's Phone <br /> T.Transpofer2 Company Name 8. US EPA ID Number B.Transporter's Phone <br /> 9.Designated Facility Name and Site Address 'r "j';, 10. US EPA to Number C.Fecal"Phone <br /> 11.Shipping Name and Description 12.Con iners 13. 14. <br /> Total Umi <br /> HM No. Type Quantity VtN'W <br /> t <br /> h. <br /> S <br /> H <br /> 1 c <br /> P <br /> P <br /> E <br /> R�d. <br /> 1 15.Special Handling Insbucton and Additional Information fl <br /> i <br /> i <br /> i <br /> #v <br /> lea.US DOT HA7.AR000S MATERIALS SHIPPER'S CERTIFICATION: Mels:oca.6y,wunoatmo-nvnxmas,amopiopeny easslnea,mscuen,aama•0.:,: ea aoa iabekd anu srein o,ap•. <br /> soon mr van nn¢on� wmee ele.aamam,u arms oopamaaxama bn. <br /> PdntedlTyped Name Month Day year <br /> re <br /> 18b.NON-REGULATED SHIPPER'S CERTIFICATION: I certify Pe matedab deso ibed above on his farm are not subject to Federal regulations for Transportation or Disposal. <br /> Pnrded{i(yped Namev ry s/s ?. e� Marta Day Yr>N <br /> r ae <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> R Prin[edfTyped Name Signature __. --i � Month Day year <br /> o 18:Tmnsporter 2 AcknoO Aedgament of Recaps of Materials <br /> R Pdntedryped Name Signawre ' ' Month DaY Ya,, <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L 20.Facility Oaner or Operator.Certification of receipt of materials covered by this form except as noted In Item 19. <br /> 1 <br /> T <br /> Y Printedfryped Name Signawre Month Day roar <br /> MR EMERGENCY#800_468_1760 t , <br /> JSArETY-KLEEN-CONT RACY#94138) <br /> FORK NO.01-90291 (call' <br />