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1.Shipper's US EPA ID No.(If Applicable) Document No. 2 page 1 <br /> BILL OF LADING/MANIFEST � 2 S� <br /> ' <br /> 3,Shipper's Name and Mailing Address Gardn P r Tr't.ti:'kint)/C lAss1C Sales In <br /> 2577 W Yoe,.Pmit: , Ave <br /> MANTECA CA 95:237-9641 <br /> 4.Shipper's Phone( 7(35-)h90--12119 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporters Phone <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transportees Phone <br /> ('LEAN HARBORS ENVIRONMENTAL. SV f INC. M91)1039322.,'5121 781 -79 :'--:.;000 <br /> 9.Designated Facility Name and Site Address W T 10. US EPA ID Number C.Facility's Phone <br /> CIJ-AN HARBORS OF W:LL_M [NGTON L.1-C <br /> 1737 EAST DENNT STREET <br /> Wf!.t?INI,,TON CA 90744 CAD0444?':39;5 .10 133.` 99'3+3 <br /> 11.Shipping Name and Description 12.Containers 13. 14. <br /> Total Unit <br /> HM No. Type Quantity WWol <br /> a. _INi ir AE-ROSOLS <br /> X FIAMMABL. ENU. S. , <br /> WhS-1-E-AER ]3O?_SI, 1IERS <br /> M I as <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 <br /> SK SHIP# GA15065 <br /> I ) ERI #126- <br /> ?4 HR EME14GENCY #1--800-468-17641 (SK / TFI ) <br /> AUTH AS "AGENT—FOR" BY (GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY <br /> DOT/PRFL_ A. 7481697f814374 H. C. D. <br /> f�7 <br /> A) NONE C> D> ) <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: T' •I`p„°i i0ty°10n e„e°OVBSB mynii1„BB1881B °aeo°a°'1a°T,°°O'm81 °'�a iae°i.a..e aron poc. <br /> Print�Name 7th ��y IY� <br /> �r •• <br /> 16b.NONREGULATED SHIPPER'S CERTIFICATION: I cerdty the materials described above on this form are A900 regulations for Transportation or Disposal. <br /> r- •- <br /> Printed/Typed Name Month Day Year <br /> as <br /> I <br /> 17.Transporter 1 AcknaNedgement of Receipt of Materials <br /> DaY Year Name C 18.Transporter 2 Ack gement of Receipt of Materials <br /> Prirr1.&Typd ` Signature Moro �fD y Yaar��J 7- h' <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 /> T <br /> V I Printed/Typed Name Signature Mond, Day Year <br /> ORIGINAL-RETURN TO GENERATOR FORM NO.01-90291(0 /2015) <br />