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upper's US EPA ID No. (If Applicable) <br />BILL OF LADING/MANIFEST <br />1 <br />3. Shipper's Name and Mailing Address (t <br />• :.era.'. ,•,.� <br />` A <br />Month <br />..__. <br />— <br />L 0 D 1 <br />d..A. <br />`;15 2 4t3 <br />4. Shipper's Phone ( *%`-, 9) , �' <br />rinted/Typed Name <br />Month <br />Day <br />5. Transporter 1 Company Name <br />ee <br />6. <br />US EPA ID Number <br />A. Transporter's Phone <br />+ <br />R <br />A Printed17YPed Name <br />Si nature <br />9 <br />Month <br />Day <br />Year <br />7. Transporter 2yCompany Name <br />8. <br />US EPA ID Number <br />B. Transporter's Phone <br />9 Desi " ated Facility Name and Site Address { ;'4 t` " t; <br />10. <br />US EPA ID Number <br />C. Facility's Phone <br />r ` C -fel, WK) <br />INC, <br />xr t.}C'+ fft� 1,v 'It,,t 'e WK)0" a.&wear. 4 <br />11. Shipping Name and Description <br />HM <br />a.gg IVINy��.VERS L A�ry,g"�''T tit?MP <br />U-1-l"IF11 E2 <br />■l7 <br />S <br />H <br />C. <br />P <br />P <br />E <br />R d. <br />115. Special Handling Instruction and Additional Information <br />cT10 4429-1129 <br />12. Containers 13. 14 <br />Total Unit <br />No. I Type' Quantity WttVol <br />7 +F ' <br />. <br />E } �$,} t 4�'D ' `] Sx`S ,^ J s:.°1 i. 3 Ps ) A) 14 a C. -f a CARRIERS <br />AS NECE'%"'AJRY <br />"This is to certify that the above-named materials are property classified, described, packaged, marked and labeled and are in prober <br />16a US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: condition fotransDortaflon according to the applicable reulations of the Department of Trans on. <br />Printed/Typed Name <br />Month <br />Day <br />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 />rinted/Typed Name <br />Month <br />Day <br />Year <br />ee <br />T 17. Transporter 1 Acknowledgem • t of Receipt of Materials° <br />R <br />A Printed17YPed Name <br />Si nature <br />9 <br />Month <br />Day <br />Year <br />ro <br />S <br />P <br />O 18. Transporter 2 Acknowledgement of Receipt of Materials <br />RPrinted/Typed Name Signature <br />T <br />Month <br />Day <br />Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />L 20. Facility Owner or Operator: Certification of receipt of materials covered by this form except as noted in Item 19. <br />T <br />Y Printed/Typed Name <br />Signature <br />Month <br />Day <br />Year <br />T/S//F COPY FORM NO. 90291 (11/96) <br />