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BILL OF LADING/MANIFEST 1.Shipper's US EPA IDNo.(If Applicable) Document No. <br /> 2.Page 1 <br /> 3.Shippers Name and Mailing Address Gardner Trucking/Classic Sales In or <br /> 2577 W Yosemite Ave <br /> MANTECA CA 95337-9641 <br /> 4.Shippers Phone( 209T-249-3204 <br /> 5.Transporter 1 Company Name <br /> SAF — YSjFMS 6. US EPA ID Number A.Transporters Phone <br /> TNr TX <br /> 7.Transporter 2 Com an Name <br /> CLEAN HPRYBORS ENVIRONMENTAL Sib INC.MAD039322250 <br /> B.Transporters Phone <br /> 9.Designated Facility Nam a and Site Address 781-792-5000 <br /> CLEAN HARBORS SAN JOSE SJ 0 US EPA ID Number C.Facility's Phone <br /> 1021 BERRYESSA ROAD <br /> SAN JOSE CA 95133 CAD059494310 <br /> 11.Shipping408-441-0962 <br /> Name and Description <br /> HM 12.Containers 13. iq <br /> a. UN1950 AEROSOLS FLAMMABLE N. O. S. , NoTotal Unit <br /> . Type Quantity WWol <br /> X 2. 1, UkIVERSAL ASTE—AEROSOILS <br /> O3 OM �a r R <br /> b. J <br /> S <br /> H <br /> 1 c. <br /> P <br /> P <br /> E <br /> R d. <br /> 15.Special Handling Instruction and Additional Information <br /> 1)ERG#126• SK SHIP# 228591798 GA15065 <br /> 24H EMERGA 800-468-1760(CH—SK—TFI)—TRANS RUTH TO RETAIN ADD' L CARRIERS <br /> DOT/PRFL A. 7481697/814374 B. C. D. <br /> A) NONE B) C) D) <br /> 1 uzr -6va-Zr a <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: <br /> ^m'�s;sm«rry mer msam�e-semea marer;als are propsdy asss;rea,aescneeo.vacua mpe <br /> Pnntad/TVped Name mnamoe rorosas uon aemm; �o mea rccanle mauons Done oe nmesrorr�'o�ro`„a saa letelea sea arem <br /> h ��, (Y r Month Year <br /> P <br /> 186.NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on this forma n subject to federal regulations for Transportation <br /> ' dnted/Typed Name <br /> or Dispos <br /> Month Day Year ' <br /> • R 17.Transporter 1 Acknowledgement of Receipt of Materials , <br /> A interd/'Ty ed Name(� <br /> N �� C%C4 <br /> S u <br />' S .r�- <br /> P M to a +Year <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials 1 . <br /> R <br /> T nn ypee} ^Me <br /> E —�� 0J - <br /> R M Pith Day y <br /> 19.Discrepancy Indication Space "7 J <br /> F 1 <br /> A <br /> C <br /> I <br /> L 20.Facility Owner or Operator:Certif anon of <br /> I of materials covered by this form except as noted in Item 19. <br /> T <br /> V Printed/Typed N me <br /> L Signature <br /> M <br /> :II rl <br /> ORIGINAL-RETURN TO GENERATOR <br /> FORM NO.01-90291(03/2015) <br />