Laserfiche WebLink
X <br /> BILL OF LADING/MANIFEST 7hipper's US EPA ID No.(If Applicable) Document No. 2.Page 1 <br /> A418r�.9 . of <br /> 3.Shipper's Name and Mailing Address <br /> 1 1 �r F_•_j �'y <br /> l.1 t\.�/�r r\t tJld <br /> 4.Shipper's Phone( 441) OOVII-3000 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporter's Phone <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transporter's Phone <br /> Name and Site Address 10. US EPA ID Number C.Facility's Phone <br /> 9.Designated�aI- Ni1t_t' A I` A. <br /> i4r �..iV4'i.t'CU9Vl� .iii 1 FiL_1 L L <br /> 700 SEAPORT Bl.-VD. <br /> REDWOOD CI TY CA 94063 C:AL-01Z 0 31 1 1,6� .i x;60—;364-102 <br /> 11.Shipping Name and Description 12.Containers 13. 14. <br /> Total Unit <br /> HM No. Type Quantity Wt/Vol <br /> a <br /> b. `' <br /> S IED <br /> Y <br /> H <br /> 1 c. <br /> P EC 1 2015 <br /> E <br /> R d. ENVIR NM TTA!HL---ALT <br /> PE RMIT SERVICES <br /> 15 Special Handling Instruction and Additional Information <br /> `its :.3ill.P# <br /> v4 HR EMERGENCY #1­800-468-1761211 800--468-1760 (SF. ! TFT ) <br /> ALITH AS "A13ENT—FOR" BY CEN TO RETAIN L-ICENSED SUB CARRIERS AS NECESSAR <br /> ))O* '/PRFL_ P. 32'99/156097 B. C. D. <br /> A) NONE B) C;) D) <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION; "This is to certify that the above-named materials are property classified,described,packaged,marked and labeled and are in proper <br /> condition for it orta6on accordin to thea Iicable re ulations of the Department of Transportation. <br /> Printed/Typed Name Month Day Year <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on this form are not subject to federal regulations for Transportation or Disposal. <br /> •' Printed/Typed Name Month Day Year • <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> A Printed/Typed Name Signature Month Day Year <br /> N <br /> S <br /> P <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printed/Typed Name Signature T YP 9 Mcnth Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <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 /> I <br /> T <br /> Y Printed/Typed Name Signature Month Day Year <br /> • <br /> GENERATOR'S COPY FORM NO.01-90291 (04/11) <br />