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BILL OF LADING/MANIFEST Shippers US EPA IDNo.(ifApplicable) DH.�men^,o. 2PPfge1 <br /> i"H 00 -.F ;_, Vit <br /> 3.Shippees Nameand Mailing Address Ciel-jnet TruCri <br /> "577 W Vnsefaite Ave <br /> MANTFI'il <br /> 4.Shipper's Phone( i A`i)ti5`75'!_.tr t th r' <br /> 5.Transporter 1 Company Name 8. US EPA ID Number A.Transporters Phone <br /> 7.Transporter 2 Company Name 8. US EPA ID Number 8.Transporters Phone <br /> f-1c <br /> l r1 HARP R ` T_NVTrONMF.NTAI_ S,rrUTr ,' <br /> ,- TNCMAnv , } 7 a <br /> 9.Designated Facility Name and She Address c T 10. US EPA ID Number C.Facilitys Phone <br /> m �1 .c f '.RYFf;SA ROAD <br /> 951 (,AiiO' > 7y, 1.0 400-441 <br /> 11.Shipping Name and Description <br /> 12.Co finers 13. 14. <br /> HM T, I Unit <br /> No. Type Quantity WWol <br /> a. UN19`50 AL rr1SC1[. S F1_r1MMABLE N. O, Se , <br /> lihIVFr�AI-. �1 :TF AFr ^n� T)N 11 P <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 /> 5K SF1II='f# i9927rd[ 6AIS0F.` <br /> _'<t r E'+IEf GENCY 1#i f 00 468 17F,0 'SF< TFT) <br /> 7U1TH AF3, "i)GENT—F-OR" RY GEN TO RETRTN l Tf-rI%ISEI) SUR <br /> wi-r.%PRFL A. 74Si697/8143i4 <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: the, 8b"inenia°""°"'�B1B ef0aeM a.ran.a,o,,,.we,n.u:.aee.,,,,,ae.,e i, W and m poi. <br /> ovaemom mraan e�m awna rant. user«.arae oe raTem <br /> (,Pnntedr, r C Name <br /> Er, �_ QU I ee, <br /> /LSO a• <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I certify,Me materials described above on this form are not subject to federal regulations for Transportation or Disposal. <br /> e Printed/Typed Name <br /> Monty Del' Year <br /> e <br /> T <br /> R 17.Transporter 1 Acknowledgement of Receipt of Materiels <br /> N 'nted fy�Name Slgn Monty y Yeer <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> T Prin /Typed Name natur <br /> /� �,/ g Month Day Year <br /> R N V/ / <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 forth except as no in Item 19. <br /> I <br /> T <br /> Y PrmtecIryped Name Sig Monty Day Year <br /> 0 <br /> .11 1 <br /> ORIGINAL-RETURN TO GENERATOR FORM NO.01-90291 (03/2015) <br />