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1 Stepper's US EPA 1D No.(If AppVicabie) Opcumen[No. pie 1 <br /> BILL OF LADING/MIANIFE T �C, �. °f <br /> 3.Shipper's Name and Mailing dressill! <br /> 4,Shippers Phone( % ) f< )' <br /> 6. US EPA ID Number A Transporter's Phone <br /> 5.Transporter 1 Company Name <br /> 1 8. US EPA ID Number 8 Transporters Phone <br /> 7.Transporter 2 CompanyName <br /> US EPA ID Number C.Facility's Phone <br /> 9 Designated Facility Name and Site Address 10, <br /> I rat , °11 '�4: (i`•. , � !• r`It' i :7t)�rMr=.(�i . `�' '..:.I <br /> C",4 <br /> ani 000--51 1 1 <br /> 12.Containers 13. 14. <br /> 11.-in,ppng Name and Description Total Unit <br /> No. Type Quantity WWoI <br /> HM <br /> t i— WO <br /> 1 t< .7 j. ''h�C.i"(' t!G•�-�Ifi C'�(iIII f�.IF. :)' � ( <br /> Cd .Jr <br /> b. <br /> S <br /> H <br /> I c. <br /> P <br /> P <br /> E <br /> R d. <br /> i5 Special Handling Instruction and Add+t nal Information <br /> 1 f t rt' r #p i ..r:�r(rr(r •Ly r..r� .,. y '7+Jt]� { i�i� F ? y"F`,t_.E.j'h1 :1'i <br /> lil ' <br /> i. } W1 N t. <br /> 16a.US DOT HAZARDOUS MATERIAL SHIPPER'S CERTIFICATION: 'This s o»rite tra the aUnve-names maUr als are propane ciaasl eo aescnoea packages marked aria,doe► ane we n P.P. <br /> cunaitw^'w Verwwrtatan aCCorOY la thea caUle r u�aUone of the Oe anmenl of Trans orlal:cr. <br /> Month Day Year <br /> II Pnnteli/Typed Name �111 NON <br /> 1 MWM6 <br /> 16b.NON-REGULATED SHIPPER'S CE TIF[CATION: I cartity rhe materials described abo+a or to s form are oat subject to federal regWetlons for Transportation or DiapersaI <br /> PnntedTyped Nerve +/ Montn Day Year <br /> 17 Transporter 1 Acknowledgement of R ceipt of Materials r <br /> R -- r, _ Month Da Year <br /> A Pnnted/TYped Name _ ,It,�rjature _ Y <br /> O 1 Tans er 2 Acknowled mans of R e t of Materials --- <br /> a Pr;ntedrryped Name Signature Month Day Year <br /> c ) I <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> L 20.Facility Owner or Operator.Canificatio,of receipt of materials covered by this form except as noted in Item 19 <br /> Y Printedilyped Ndriiv 6rgneturr. Y__ nn..,rn f?ay v.:nr <br /> t: .1 <br /> (iF N[. 11, FORM NO.0 9%291 (iter( <br />