Laserfiche WebLink
1.Shipper's US EPA ID No.(If Applicable) Document No. 2 Page 1 <br /> BILL OF LADING/MANIFEST .61Lt S, of <br /> 3.Shippefs Name and Mailing Address Gardner TruckingJCl assic Sales In <br /> 2577 W Yosemite Rve <br /> MANTECR CA 95337-9641 <br /> 4.Shippers Phone( 785-7690-0109 <br /> 6. US EPA ID Number A.Transporters Phone <br /> 5.Transporter 1 Company Name <br /> -'1 <br /> C <br /> 7.Transporter 2 Com any Name B. US EPA ID Number B.Transporters Phone <br /> 9.Designated Facility Name and Site Address <br /> Si US EPA ID Number C.Facility's Phone <br /> CLEAN HARBORS SRN JOSE LLC <br /> 1021 BERRYESSA ROAD <br /> SAN JOSE CR 95133 CAD059494310 408-441-0962 <br /> 12.Con finers 13. 14. <br /> 11.Shipping Name and Description Total Unit <br /> No. Type Quantity WWol <br /> HM <br /> a. UN1950 AEROSOLS, (EACH NOT EXCEEDING <br /> DM <br /> X 1 L CA�ACITY) , 2. 1, UNIVERSAL WASTE– <br /> AEROSOLS <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# GA15065 <br /> 1)ERG#126• <br /> 24 HR EMERGENCY #1-800-468-1760 (SK / TFI) <br /> RUTH AS "AGENT–FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECEScSPPY <br /> DOT/PRFL A. 7481696/814374 B. C. D. <br /> R) NONE B) C) D) 4160-3 ?.)-6 / -28 <br /> ,S6 <br /> 16a.US DOT HAZARDOUS MATERIAT=yaclf <br /> ON: r mremrymeimsauoee-�amee mmsnaaare oreoseyaas aNteeesmusa.wf Trans,ma ant!Wa am musisa and are in woos <br /> meanpn roro-ans onauonaccona to the sam ramie wme De emorrreoa oos. <br /> nnted/Typed ame — m Day Year x Ill Sl 110 <br /> 16b.NON-REGULATED SHIPPERIS CERTIFICATION: certify the materials desoribed above on this form are not su jacttofederal ulations for Transportation or Disposal. <br /> •' Printed/Typed Name Monro Day year <br /> ra <br /> T 17. ansporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> A 'me�dr(�T� p@\tl Name Si re yp(pfn Oay Year <br /> P <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> RPrintedlTyped Nam Signature n1 fn e r <br /> 7 <br /> E <br /> R <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 /> Y Print yped Name Signatu Mcnm Day year <br /> FORM N0.01-90291 (0312015) <br /> ORIGINAL-RETURN TO GENERATOR <br />