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I ! It <br /> 1.Shipper's US EPA 10 No. low int No 2 P I <br /> ILL OF LADING/MANIFEST Of <br /> [�QJ19AJ J-A-ZQLZ e> gi <br /> 3.Shipper's Name and Mailing Address'.TrGQKT0N UNIFIET <br /> 2963 BANGLE INFI-T! LAN ' <br /> `7 MIN C i 1 0 llt�,, <br /> 5TOCK <br /> 4.Shipper's Phone 43:.79 3--417118.4 <br /> 5.Transporter I Company Name 6. US EPA 10 Number A.Transporter's Phone <br /> TV-4fl EEN, ti,y,i sl P T N <br /> 7,Transporter 2 Company Name 8. US EPA 10 Number B.Transporters Phone <br /> 9.Designated Facility Name and Site Address 10, US EPA ID Number C.Facility's Phone <br /> 6 SEAPORT TU-VD, <br /> r <br /> L,Al"XIC"ID f",T-1 y _-i AT -9 4 0 1 A L..0 W3 0 31 1 1g 0,,:`4 <br /> 11.Shipping Name and Description 12.Containers 13. 14 <br /> Unit <br /> HM No. I Type Quantity Un <br /> n' <br /> ty WtIvol <br /> a. <br /> WON..RE"(31iLATED L101—il"D rVAC-011 WATF-R, <br /> BL UD-+G MOT UcEiDOTMU!" usETA i�HIJUIT'r:0) 'I T <br /> qS q <br /> b. <br /> S <br /> I C. <br /> P <br /> P <br /> d. <br /> 15.Special Handling Instruction and Additional Information <br /> BF( sHIP# I 1 61 7 <br /> F. 1-,i11FR- E111If i" (f3AvF`ETY---KLr--'t N 'D—4 38 <br /> uIBSECAUEN F C"."f,R R,Y FRIE3 3 N, F! F-.S <br /> "RITZE"T 'rO RE UN [ArCENSED -9 y <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION:• '='nd-ftJl Jlonw-rfy thaddie abov�d materials are properly dassified,described,pa*aged•marked and labeled and are in proper <br /> Printed/Typed Name for tranition I to the!Wicable sulaffam of the Departalent of Twaportation. Month Day Year <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above an this fo rnn are not subject to"ral regulatigns for Transportation or Disposal. <br /> • ,PrintedlTyped Name Month Day Year <br /> TO e <br /> R 17.Transporter I Acknowledgement of Receipt of Materials <br /> nt ype Sig re A Name Month Day Year <br /> N <br /> eW U M <br /> P YLi4 <br /> 0 18.Trans iter 2 Acknowledgement of Re pt of Materials <br /> R <br /> T Printed/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <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 Printedfryped Name Signature Month Day Year <br /> GENERATOR'S COPY FORM NO.01-90291(11/0! <br />