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i.Shipper's US EPA ID No.(If Applicable) Document No. 2.page 1 <br /> BILL OF LADING/MANIFEST _ Of <br /> 3.Shipper's Name and Mailing Address Gardner TY"uckiTtg/CIa»1.c 'Sales in <br /> ''577 W Yosemite Ave <br /> MANTECA C A 953 ,7- '�s>4i. <br /> 4.Shippers Phone( 7851-6913-0109 <br /> {. 6. US EPA ID Number A.Transporter's Phone JXJ <br /> 5.Transporter 1 Company Name _ <br /> SAFETY--KI FEN SY T �. �. -' -. <br /> 65-2000 <br /> 7.Transporter 2 Com any Name r 8. US EPA ID Number B.Transporters Phone _ <br /> CLE i7 H��f?F+ORS ENVIRONMENTAL RVIGES INCMA001-29322 5 7R1—ISc— 430 <br /> 9.Designated Facility Name and Site Address W I 10. US EPA ID Number C.Facilitys Phone <br /> AN HARBORS OF WI <br /> LM:[NGTON LLC <br /> 4737 EAST DENNT STREET - <br /> WILMINGTON CA 90744 CAD0444 :9835 lett-83',-_1999£3 ° <br /> 12.Containers 14. <br /> 11,Shipping Name and Description Tota73.l Unit <br /> No. Type Quantity wt(voi <br /> HM <br /> a. t_EN1c_ 950 AEROSOLS FLAMMABLE N. O. S. s , <br /> X . 14 U IIVERSAL WASTE—AEROSOLS 1}MJ <br /> b. <br /> S <br /> H <br /> I c. <br /> P <br /> P <br /> E <br /> R7_ <br /> 15,Special Handling Instruction and Additional Information aa),5L[ugLls - <br /> SK SHIP# P_tL � RA15065 <br /> 1) ERG#126 <br /> 24 HR EMOGENCY #I -8110-468-1760 (SK ! TFT) <br /> AUTH AS "AGENT-FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSAt<'. <br /> DOT/PRFL A. 7481697/814374 B. C. D. <br /> Ai NONE B) C) D) <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: "Thou to csrofy mat me abwe-namea mmmaie arep rtydaeemea,ae.s. d,pacwapae.mance"andiabeudamamom,er <br /> mmmonroruare uoeamea cane Bore Orme oe mran or Crena <br /> Pfinietl/TyQgd Name + Monts Day Year <br /> o LLLr <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: Icedify Memateabdescribedabov mo islomaren ect fedemlregulatimsfm Tmnsportatimor Disposal. <br /> •" Printed/Typed Name Month Day Yeer <br /> •• <br /> T <br /> R 17.42nsporter 1 Acknowledgement of Receipt of Materials <br /> A rinted/T ed Nam M Si natu Month Day Year <br /> P <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> TR ed.LJame Signatu Month Day Year <br /> E J(/�� <br /> R <br /> 19. iscrepancy 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 /> 1 <br /> T <br /> Y Printed/Typed Name '�o Signature Mmfh Day Year <br /> ETrej3o {}rG1(cIv-„ w� b l0 Ll <br /> :24 HR EMERGENCY#800-468-1760 <br /> ORIGINAL-RETURN TO GENERATOR FORM No.0r9_029_1("3/z015) <br />