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I.Shipper's US EPA ID No.(if Applicable) Document No. 2.Page 1 <br /> BILL OF LADING/MANIFEST �_„r ` L� of <br /> 3.Shippers Name and Mailing Address i i”io t;i 11.t a C:orpo ra loll <br /> ..340 W SrfattS Ave <br /> STOCKTON <br /> A.Shippers Phone( -)r948—0637 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporters Phone <br /> 7.Transporter 2 Company Name .8. US EPA ID Number B.Transporters Phone <br /> CLEAN HARBORS ENV EVC INC. MAU039. T61--79F-5000 <br /> 9.Designated Facility Name and Site Address S J 10, US EPA ID Number C.Facility's Phone <br />' C,L.i:AN HARBORS SAN JOSE <br /> 1021 DF.RRYFSSA ROAD <br /> BAN JOSE CA 95133 CAD05'J49431 0 406•.•441- 0'+4 , <br /> 11.Shipping Name and Deschption 12.Containers 13. 14. k <br /> Tctai Unit <br /> HM No. Type Quantity 1NIIVol <br /> a UN2794 BATTERIES WET FILLET) WITH <br /> X ACID, hl (UNIVERShL WMT'E--BATTERIES) <br /> b- UNIVERSAL RSAL WASTE LAMPS <br /> l <br /> (FLUORESCENT LAMPS) <br /> S1 <br /> H <br /> P <br /> P <br /> E <br /> R d <br /> ni <br /> i <br /> 15.Special Handling Instruction and Additional Information <br /> SK SHIP# 231.1 E,0761 M€i4r'790 <br /> 1)ERG#154- <br /> 24H EMIwRG4 800--468--'1'760(;H—SK--TFI )—'TRAINS AUTH TO RF'TATN ADD' L CARki,Lr:- <br /> DOT/PRFL A. 8829100/172'72R3 B. 14815/150228 228 C. D. <br /> A) NONE B) NONE C) D) <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION' "This is to certify that the above-named raalanals are properly dassified.described.packaged,marked and labeled and are in proper <br /> condition for trees ortarion accordin to the applicable ro ulatiens of[he Da admant of Transportabi <br /> Printed/Typed Name Month Day year <br /> i6b.NON-REGUL D HIPPER'S CERTIFICATION: I certify the materials described above on this form are not subject tod regulations for Transportation or Dsposal, <br /> •' Month Da Year <br /> Printed/Typed Name Y <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> A P�nted(Typed Name Signature r Month Day Year <br /> N f <br /> O 18.Transport 2 Acknowledgement of Receipt of Materials <br /> TPrinted/Typed Name Signature Month Day Year <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 farm except as noted in Item 19. <br /> I <br /> T <br /> Y Printed/Typed Name Signature Month Day Year <br /> :11 .1 <br /> GENERATOR'S COPY FORM NO.01-90291 (0312015) <br />