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BILL OF LADINGWANIFEST 1.Shipper's US EPA ID No.(If Applicable) Document No 2.Page 1 <br /> 1 CAI 000375509 4 6 rK of <br /> I3.Shippers Name and Mailing Address RD Lab Rubber CO. Inc. <br /> 8830 W Linne Rd <br /> ' TRACY CA 35504-919 <br /> r <br /> 4.Shipper's Phone( 209x836-0965 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporter's Phone <br /> t�ei <br /> J . J_J C.__• <br /> 7.Transporter 2 Company Name & US EPA ID Number 7 B.Transporter's Phone <br /> CLEAN HARBORS ENVIRONMENTAL S C INC. MAD03932225O 781-792-5000 <br /> 9.Designated Facility Name and Site Address SJ 10. US EPA ID Number C.Facility's Phone <br /> CLEAN HARBORS SAN JOSE <br /> 1721 BERRYESSA ROAD <br /> SAN JOSE CA 9513`3 CAD059494 3 10 408-441-0962 <br /> 11.Shipping Name and Description 12.Containers 13. 14. <br /> Total Unit <br /> HM No. I Type Quantity Wt/vol <br /> a. UN1950 AEROSOLS, (EACH NOT EXCEEDING <br /> X 1 L CAbACITY) , 2. 1, UNIVERSAL WASTE- DM P <br /> AEROSOLS 0.ri. Ci.C) <br /> S <br /> H1 <br /> I c. <br /> P <br /> P <br /> E <br /> R d. <br /> 15.Special Handling Instruction and Additional Information `�v•S tr) GAJ <br /> SK SHIP# R0154 9 <br /> I)ERG#1E6• '' <br /> 24H EMERG## 800-468-1760(CH—SK—TFI)—TRANS AUTH TO RETAIN ADD' L CARRIERS <br /> DOT f PRFL A. 7886317/11871585 B. C. D. <br /> A) NONE B) C) D) <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION' This is to certify that the above-named materials are properly classified,described,packaged,marked and labeled and are in proper <br /> condition for transportation accordin to the app livable Mations of the Department of Transportation, <br /> Printed/Typed Name Month Day Year <br /> 16b NON- GULATED SHIPPER'S CERTIFICATION: I certify the materials described above on this form are not subject to federal regulations for Transportation or Disposal. <br /> • <br /> Prinf6ldrryped Name Month Day Year <br /> T 17.Transporter 1 Acknowledgement of Receipt ofM terials <br /> R <br /> A rin /Typed Name - gnature Month Day Year <br /> P — — _1 4 <br /> 0 1 ransporter 2 Acknov4qdgernent of Receipt o erials <br /> R Printed/T ed N e Signature T yp g M DayCX, Ye <br /> R tl <br /> 19 Discrepancy Indication Spac <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 /> I <br /> T <br /> Y d/Ty ed ame Signatu Month Day Year <br /> 24 HR <br /> /V1 800-468-1760 <br /> ORIGINAL-RETURN TO GENERATOR FORM NO.01-90291(03/2015) <br />