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oqlor7--N <br /> =. BILL OF LADING m r - Bate f Pae)Cttp�'�" <br /> YY <br /> Page of 4 =K 19 <br /> GeneratMaflirt Address11e1y Phonet (877)577- 669enerator's Site Address ifdifferent than mai�in address <br /> 8tG LST304 PHILDENA t=ERARU DIG LOTS#4457CbLUMN ('514)27g 4814 X81 N.TRACY BLVD. <br /> TRACY,CA 95376 209$306312 <br /> HM US 00T Dese_ziption(frlcluding Proper Shipping Name,Hazard Class and 11)number) Containers <br /> Total Unit <br /> S_ <br /> No. T pe/Size Quantity Wt./Val. State Waste Codes <br /> 2. NON DOT REGU— ELECTRUNIC WASTE <br /> DF 17 P <br /> x <br /> 4. - <br /> AdUitionar lnfnrmatiowlab Code <br /> (2)BLEWASTE-04-CRWo E WASTE <br /> 53 <br /> Contract/PONG. SPeciial irtsni tior>s/Reawas for Cletay <br /> N6:of Overpacks mea <br /> Start Time _ <br /> Arrival at Customer <br /> Departed Customer �. <br /> Delay Time <br /> GENERA 3d}PiCEttt3FICA710N <br /> "1 hereby declare that the contents or th' merit are( <br /> IabeocWplatartted,and are in aN in `arld actettateiy desrn os�by pr , ame and c! "tied, <br /> Ix candikiotr fOr pack.Wd,marked and <br /> times list. ve a true and ect. transport aceprding t plicable int �rui and ti.na! <br /> rristlent regulations"1 also cet1ify.ihI <br /> Print Hartle-,;, 1 - <br /> [iotaoe <br /> . <br /> Tractor t' Trailer# <br /> Transporter#1 Box Spotted# $ox Picked 1fp# <br /> Liner . w n•, <br /> NAME <br /> Phone <br /> Print Nape R� EPA ID NDr.-, f <br /> Tralisporter#2 �^ t oil Date 4 29 19 <br /> NAME ] rUlf '� <br /> Phone <br /> Print dame { <br /> - TSDF Arrival Time Date Vr r' <br /> TSDF Departure Time. _ Rea-son for Delay <br /> Delay Time <br /> Finish Time" <br /> Contact <br /> —�...- Broker_ <br /> Cosignee/Treamentf5torage/t}isposal Facility EPA identification Code NQ. NVOgNS95338 <br /> Cosigned To:21 St Century Envlr9nmental Management of Wvada LLC <br /> 2095 Newlands Dr.East, <br /> Fernley KV 89408 (775)575-2760 <br /> This is to Certify the acceptance of this waste far treatrrleref storage d' Msa! <br /> Print Name w <br /> Date <br />