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BILL OF LADING/MANIFEST 1.SlppersUSEPA IDNo.(IfApplicable) DocifinentNo. 2Page1 <br /> �p��1 S I Of <br /> 3.Shippers New and Mailing Address Gardner Truck Ing/Classic a e s in <br /> 2577 W Yosemite Ave <br /> MANTECA CA 95337-9641 <br /> 4.Shippers Phone( 7a5-1690-0109 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporters Phone <br /> SAFETY=ELEEN SYSTEMS INC TXROOOOS-1205 972-269-2000 <br /> 7.Tmns 2 Compan rriI�ma 8. US EPA ID Number B.Transporters Phone <br /> CLAN HAR)�GRS IENHIRONMENTAL SU F INC. MAD039322250 781-792-5000 <br /> 9.Designated Facility Name-mW 616Adtkgss WI 10. US EPA ID Number C.Facility's Phone <br /> CLEAN . NGTON LLC <br /> 1737 <br /> WILMII 90744 CAD044429835 310-835-9998 <br /> 11.Shipping Nam (h 12.Con iners 13. 14. <br /> �t Total Una <br /> No. Type Quantity WWol <br /> a FLAMMABLE N. O. S. , <br /> r15TE—AEROSOLS DM P <br /> p <br /> 4, <br /> 1 <br /> u„}1111 Additional lnfomlatim W . <br /> X� SK SHIP# aia3� BA15065 <br /> Y #1-800-468-1760 (SK / TFI) <br /> T—FORT BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY <br /> Mme, <br /> A. 7481697/814374 B. C. D. <br /> C) D) <br /> kr �. C2 <br /> . :MATERIALSSNIPPEWS CERTIFICATION: mihhew`°h'°'°t"'°°°°"°""'"`°"w'^'m°'°M°a^v°'°"°°°.as e°°.^°°'°s°°•"'°^m°"°'°°.I°°°^°are^were' <br /> .... wntlNw fwbam tion a+aidl WtlKa 14Eem atlb nmem°(Tnn an. <br /> Month Day D� ly� <br /> ew <br /> ee <br /> ER'S CERTIFICATION: I certify the materiels described above on this form are rmt subject W f"g ations for Tmns.Wtadan or Disposal. <br /> MorDay Yew <br /> as <br /> : .Id4!l►NledgameM of Receipt of Materials <br /> Signa Month De Year <br /> • ...5 edgemem of StaosiptAt Materials ` <br /> gnature Ile Month Day Year <br /> by Indloation space <br /> .Fs lty6"mar wOpe2toc Certification of receipt of materials covered by this form except as noted in Item 19. <br /> Y 'PtdttedlTyped Name <br /> ^ A 9 S gnemre Mand Day <br /> IYT <br /> •�r .r <br /> ORIGINAL-RETURN TO GENERATOR FORM NO.01-90291(0312015) <br />