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BILL OF LADING/MANIFEST 1.Shippers US EPA ID No.(If Applicable) Document No. <br /> _ j 2.Page 1 <br /> 3-Shippers Name and Mailing Address�c'i T'dn Qt' }^i,tC ing/Classic ale ls In of <br /> c_577 W YDsel6i.te Ave <br /> MANTECA <br /> CA 95337-9641 <br /> 4.Shippers Phone( 7/35-169¢1—pt 1q <br /> 5.Transporter 1 Company Name <br /> SAFETY—K ENQYSTEMS INC <br /> 6. US EPA ID Number <br /> A.Transporters Phone <br /> 7.Trans her 2 Compan Name <br /> Ct- AN HARE�ORS ENVIRONMENTAL. SV6 INC. MAD039„ 'erg�0 7 _. <br /> US EPA ID N�bar _e B.Transporters Phone <br /> 9.Designated Facility Name and Site Address . ' . 781--792-5000 <br /> WIT 10. <br /> CI-FAN HARBORS (IF WILMINGTON LLC US EPA ID Number <br /> 1737 EAST DENNI STREET C.Facilitys Phone <br /> WILMINGTON CA 90744 <br /> CAD044429835 <br /> 11.Shipping Name and Description `�1 `"S 5-9998 <br /> HM 12.Containers 13. <br /> a. Total 1A. <br /> 1N CA AEROSOLS (EAS No. type Total <br /> unit <br /> X i L Cfl�'flCITY) � ' H NOT EXCEEDING Quantity wwpl <br /> EROSOLS ' 1a UNIVERSAL WASTE— <br /> b. ( DM ' d U P <br /> S <br /> H <br /> I c. <br /> P <br /> P <br /> E <br /> R d <br /> 15.Special Handling Instruction and Additional Information ay <br /> 1 )ERG SK SHIP# a3ti l,a <br /> P.4 HR#EME '—' GAIS065 <br /> f'2GENCY B -468-1760 (SK / T <br /> AUTH AS "AGENT—FOR" <br /> By GEN TO REFI)TAIN LICENSED SUB CARRIERS AS NECESSARY <br /> DOT/FREE A. 7481696/814374 C. <br /> A) NONE B) C) D) B. D. <br /> I .1 c*2'�(K <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: My harm•ayo•.a-aamaa mam,;ay„a gyp, aamrree,e <br /> Print 'tbu u m ca <br /> „ YPed Name mndmon m.o-am xon xwmi amea icaaa i+auona mme oa omagad d and uaamaam are in pmW <br /> 16b.NON-REGULATED SHIPPE CEx n Month Dalar <br /> ypetl ) Ye <br /> a Prmted(r RTIFICATION: I certify Me materials despibed above on this i C".1 Q <br /> Name orm ere not subject to federal <br /> ulations for Transportation or Disposal <br /> • R 17.Transporter 1 Ackin aMonth Da a' <br /> 9emenf of Receipt of Materials a a Y <br /> A <br /> near <br /> N ntedR Name - <br /> f - x <br /> P L� Sig <br /> R16.Transporter 2 Acknowledgement of Receipt of Materials -�� Month Day Year <br /> T !f me <br /> E J S' lure <br /> 19.Discrepancy Indication Space Month pa„ <br /> F l d! <br /> A <br /> C <br /> 20.Facility owner or Operator:Certification of receipt of <br /> T materials covered by this form except as noted in Item 19. ' <br /> Y Printed/Typed Name <br /> Signature <br /> Month Day Year�1 <br /> 11 I ,.S <br /> ORIGINAL-RETURN TO GENERATOR 4 <br /> FORM NO.01-90291(03/2015) <br />