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BILL OF LADING/MANIFEST 1.Shippers US EPA to No.(If Applicable) Document No. 2Page 1 <br /> 41, of <br /> 3.Shippers Name and Mailing Address iJ:xY U'—neer- ) r uc2ki1 qrC1a5s SC dales IT) <br /> 2577 W Yosemite Ave <br /> MANTECA CA 95.337-9641 <br /> 4.Shipper's Phone( '_; 54690-0109 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporters Phone <br /> 7.Transporte 2 Company IN B. US EPA ID Number B.Transporters Phone <br /> O� e 6 & '(S r <br /> 9.Designated Facility Name and Site Address 10, US EPA ID Number C.Facility's Phone <br /> AN JOSE <br /> 'TOAD <br /> CA 95133 CAD0594 - <br /> 1 t.Shipping Name and Description 12.Containers 13, 14. <br /> Total Unit <br /> FH_M_j No. Type Quantity WWol <br /> a. IJN1950 AEROSOLS FLAMMABLE N. O .^ <br /> 1, UNIVERSAL WYSTE—AEROSOLS ©� <br /> b. <br /> S <br /> H <br /> I c. <br /> P <br /> P <br /> E <br /> R d. <br /> T_ <br /> 15.Special Handling Instruction and Additional Information <br /> 1 ) ERG#126 <br /> 24 HR EME6ENCY #1-800-468-1760 (SK / TFI ) <br /> RUTH AS "AGENT—FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSAR <br /> DOT/PRFL A. 7481697/814:374 B. C. D. <br /> A) NONE B) C) D) <br /> �� I WO 3 14'No� <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: This"W cendy mat neaoove-named realrersdare properly dandified.deadhead.pabkayed,manned and iadeied and are in pmw <br /> mndi for transidonabon acmrdln t teapplinableuWtonsoftNDepadmentafTmnnpmation. <br /> Q <br /> Rrinted/Ty d Name <br /> San-, <br /> 'e, �4 Monfh Day Year <br /> Cf/ � �O 0416 <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials hesaibetl above on Uis form are no[subject to federal gulations for Transportation or Disposal. <br /> •• PrintedFryped Name <br /> Month Day Year <br /> T <br /> R 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> A 'VTrintedrrypl Name Sign Month oay v ar <br /> P U^ cG ✓-- 1 v I� <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R Print ed Name nature <br /> T p . 9 Month Day Year <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 /> V Printed yped Name Signature Month Day Yea <br /> ORIGINAL-RETURN TO GENERATOR FORM NO.01-90291(04/11) <br />