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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 />1 <br />T <br />Y PrInted/Typed Name Month Day Year <br />-IR EMERGENCY # 8U0 -4b8-1760 <br />FETY-KLEEN-CONTRACT #94138) <br />ORIGINAL -RETURN TO GENERATOR FORM NO. 01-9 <br />1 1. 0 — k'. _V, __­ _­,,,_, <br />BILL OF LADING/MANIFEST <br />Ile. rage I <br />Of <br />CA[_0!a@aC-,6 <br />3, Shipper's Nam and.Malling Address F i re St on e 0,28746 <br />720 E Hammer Ln <br />Stockton CA 95210-2'736 <br />4. Shipper's Phone( <br />5, Transporter I Company Name 6. US EPA to Number <br />A. Transporter's Phone <br />SAFETY—KLEEN SYSTEMS, INC. :TXRO1Zt*0081&%5 . . . <br />972-265-2000 <br />7. Transporter 2 Company Name 8. US EPA to Number <br />B. Transporters Phone <br />9. Designated Facility Name and Site Address .1. i_2958 10. US EPA ID Number <br />C. Facility's Phone <br />SEAPORT REFINING & ENVIRONMENTAL, LLC <br />700 S"E'EAPORT BLVD. <br />REDWOOD CITY CA 94063 CAL000311135 <br />650--364-1024 <br />11. Shipping Name and Description <br />12. Coniners <br />I <br />Tot13. <br />al <br />14. <br />Unit <br />F -H -M7 <br />No, <br />Type <br />Quantity <br />wtival <br />--I <br />LIQUID (VAC--DIL WATER <br />-r <br />JNON--RE <br />SILUDDE) (NOT -USDOT/NL-1T USEPA RLGULAT�D) <br />T <br />6 <br />(NOT CA REGULATED) <br />b. <br />H <br />I <br />c_ <br />P <br />P <br />E <br />R <br />d. <br />16. Special Handling Instruction and Additional Information <br />SK SHIP# 208490502 <br />3399729 <br />24 HR EMERGENCY #1-800-468-1760 (SAFE TY--KLEEN <br />CONTRACT #94138) <br />SK AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS <br />AS NECESSARY <br />DOT/PRFL A. 3299/150Li,51 B. C. D. <br />A) NONE B) C) D) <br />'This Is to cert -named materials are properly classified. described, packaged• marked and labeled and are In proper <br />16a. US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: 00ndfilonfor tra accordi to Meapplicable regulatlons OVU10 1100artment Of Transportation, <br />Printe&'ryped Name <br />Month Day <br />Year <br />gFLq <br />16b. NON-REGULATED "PPEITS CERTIFICA/TIONYI certify the materials described above on this form are not subject to ted eryrqations <br />for T)VV/Itallon or Disposal. <br />PrInted/Type <br />V <br />Month Day <br />Year <br />X �r/ � ljd <br />T <br />R <br />17. Transporter I Acknowledgement of Receipt of Materials/ <br />A <br />nted yped Name <br />Sig tune <br />Month Day <br />Year <br />N <br />^ <br />b. <br />rJen <br />STA147 <br />lam <br />P <br />0 <br />18. TranspVner 2 Acknowledgement of Re6loof Materials <br />Rrd <br />T <br />nted/Typed Name <br />Signature <br />Month Day <br />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 form except as noted in Item 19. <br />1 <br />T <br />Y PrInted/Typed Name Month Day Year <br />-IR EMERGENCY # 8U0 -4b8-1760 <br />FETY-KLEEN-CONTRACT #94138) <br />ORIGINAL -RETURN TO GENERATOR FORM NO. 01-9 <br />