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1.Shipper's US EPA I D No.(if )cument No. <br /> �5 2.Page 1 <br /> BILL OF LADING/MANIFEST 7 of <br /> 3,Shipper's Name and Mailing Address RO Lab Ri..ibbar Co. Ivica. <br /> 8830 W Linne Rd <br /> TRACY CA 95304-9109 <br /> 4.Shipper's Phone 209r836-0965 <br /> 5.Transporter I Company Name 6. US EPA 10 Number A.Transporters Phone <br /> SeFFTY-El EVEN SYSTEMS INC I X 200008 1205. . . 972-265-2000 <br /> 7.Transporter 2 Company Name US EPA ID Number B.Transporters Phone <br /> CLEAN HARBO RS ENV I RONMENTAL. Sif C I NC. MAD039322250 781-792-5000 <br /> 9.Dei Fai Name and Site Address W 1 10. US EPA ID Number C.Facility's Phone <br /> CLEAN HARBORS OF WTI-MINGTON <br /> 173_7 EAST DENNI s7REET <br /> WILMINGTON CA 90744 CAD044 429.835 310-835-9998 <br /> 11.Shipping Name and Description 12,Containers 13. 14: <br /> Total Unit <br /> No. Type Quantity Wt/Vol <br /> HM <br /> a. _A4 C�V <br /> UN1950 AEROSOLS, (EACH NOT F-XCEEDIN13 2- <br /> X I 'L CA�ACITY) , 2. 1, UNIVERSAL WASTE- DIA <br /> AEROSOLS <br /> b. <br /> S <br /> H <br /> P <br /> P <br /> R 7- <br /> 15.Special Handling Instruction and Additional Information <br /> 'K SHIP# 227717535 R015429 <br /> 1)ERG#12,6; <br /> L 800-468-1760(CH <br /> 2411 EMERG -SK--TFT )-TRANS AUTH TO RETAIN ADD" L CARRIERS <br /> DOT/PRFL. A. 7886317/1187585 B. C� D. <br /> A) NONE B) C) D) <br /> 7his s to certify that the above-named materials am property classified.descnbed packaged.marked and I�Ibelad and Ai in pmper <br /> 1113a�US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: nindifirm,ffir tragrainn.0 to the applii regulations of the Department of Tiain*eortation. <br /> Pn'ntedfTyxd Name k) month Day Year <br /> 10 <br /> 16b.NON-REGULATEb SHIPPER'S CERTIFICATION: I oertify the materials described above on this form are n4ubject federal regulations for Transportation or Disposal. <br /> PrintedrTyped Name Month Day Ye.- <br /> T 17.Transporter 1 AcknowJedgement of Receipt of Materials <br /> R ---7i,natu- <br /> A Printed/Typed Narre I , 0"?"( Month, D Year <br /> 4"C310 <br /> P E� <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Matedals <br /> R /T 4PMe Signa Month Day Year <br /> SLL <br /> T ed/-Fypp <br /> E '_� (:_– ( <br /> R 7- <br /> 11 Discrepancy Indication Space <br /> A <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 /> &gnature Mooth Day Year <br /> C __/V 1,�,qjt <br /> 3 <br /> y PrintedfTyped Name <br /> ism <br /> ORIGINAL-RETURN TO GENERATOR FORM NO.01-90291 (10"112015) <br />