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BILL OF LADING/MANIFEST I-Slipper's US EPA ID No.(If Applicable) Document No. 2 Page <br /> CALO = ^832 I of <br /> 3.Shippers Name and Mailing Address Gardner rrlc ing assic Sales In <br /> 22577 W Yosemite Ave <br /> MANTECA CA 95337-9641 <br /> 4.Shippers Phone( 7857690-0109 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporters Phone <br /> SAFETY—KLEEN SYSTEMS INC. I TXR000081205 . 9372.-265--' ]a <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transporters Phone <br /> 5 <br /> 9.Designated Facility Name and Site Address Si 10. US EPA ID Number C.Facility's Phone <br /> CLEAN HARBORS SAN JOSE LLC <br /> 1021 BERRYESSA ROAD <br /> SAN JOSE CA 95133 CAD059494310 408-441-0962 <br /> 11.Shipping Name and Description 12.Conti iners 13. 14. <br /> Total Unit <br /> HM 1 No. Type Quantity WWol <br /> a. UN1950 AEROSOLS, (EACH NOT EXCEEDING <br /> X 1 L CAkEITY) , 2. 1, UNIVERSAL WASTE— <br /> AEROSOLS JJ <br /> b. <br /> S <br /> H <br /> I C. <br /> P <br /> P <br /> E <br /> R d. <br /> 15.Special Handling Instruction and Additional Information <br /> SK SHIP# r�tT�RTT T+�' GA15065 <br /> 1)ERG#1226• <br /> 24 HR EMERGENCY #1-800-468-1760 (SK / TFI) <br /> RUTH AS "AGENT—FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSAR' <br /> DOTNONE 7481696/814374 B. C. D. a� 1W ZZ-5-7 -3d <br /> A) NONE R)) C) D) J6 � <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: 'hat.m Wray,mai the aeove-named meianal:am Poopany dassmad,descriead,pa=luagd,manoe and iaceied and are at proper <br /> anndgmn for vans or,00n acooram to one noolicalatt hadamboas of me De artmmn or Trans ortaten. <br /> Pdnted/T ed Name Month Qey Year <br /> z- •• 1 l2 ItO <br /> 16b.NONREGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on this form are not subject to fedeltal regulations for Transportation or Disposal. <br /> • Printed/Typed Name Month Day Year - <br /> aa <br /> T <br /> R 17.k2nspaorter 1 Acknowledgement of Receipt of Materials <br /> SMin /Type L>^ Sign �— month Day Year <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> 6 Printed/Typed ed Name Signature T YP 9 Month Day Vear <br /> E <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 /> 1 <br /> T <br /> Y Pdnted yped Name Signa Month Day Year <br /> V O <br /> ORIGINAL-RETURN TO GENERATOR FORM NO.01-90291(03/2015) <br />