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BILL OF LADING/MANIFEST 1-Shippers US EPA ID No.(If Applicable) DocumentR No. 2 Page <br /> SP, , ".49 . k I <br /> .3of <br /> - 3.Shippers Name and Mailing Address RD Lab R,_ Inc, <br /> 8830 W L1.t:t,,, <br /> TRACY CA 95304-9109 <br /> 4,Shippers Phone( r -� <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporter's Phone <br /> .-. _ Y.. .-., .. — <br /> 7.Tiansporter 2 Co parry Name Q r <br /> GSI&A-Id t�Iumb r B.Trans,:a Phone <br /> 9.Designated Facility Name and Site Address Si 100_.l1vMT1 US EPA ID Number C.Facility's Phone <br /> :LEAN HARBORS S3AN JUSE= <br /> 10'=`I 1WRRYFSSA ROAD <br /> CA 95133 CADS X4943141. 400 <br /> 11.Shipping Name and Description 12.Gonta iners 13. 14. <br /> Total Unit <br /> HM No. Type Quantity Wtrvoi <br /> UN1950 AEROSOLS, (E=ACH NOT EXCEEDING <br /> Y 1 L CA�ACITY), 2. 1, UNIVERSAL WASTE— <br /> a. � DEd 2�Q <br /> AEROSOLS <br /> b. <br /> S <br /> H <br /> C. <br /> P <br /> P <br /> E <br /> R d. <br /> 15.Special Handling Instruction and Additional Information <br /> SEC SHIPi# 220866391 RO15429 <br /> 1)ERG#126 <br /> -'4 HR EMERGENCY #1-800-468---1760 (SES / TFI) <br /> AUTH AS "AGENT—FOR" BY GEN TO RE=TAIN LICENSED SUES CARRIERS AS NECESSARit <br /> DO'F/PRFL A. 78615 1.7/11.87515 B. C. D. <br /> A) NONE B) C) I)) I <br /> Aha.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: ceaay mai ma aoo,e-cameo m are Pbo.>y uass� d.ec.l� era,maMed arra iauei a and am,n oraaer <br /> air n mr o-am n.noa auorem tom name re waao� enc❑ nt or onafpn. <br /> PrintedTTyped Name - Month Day ye <br /> CA Z4A V I Lk l 7 <br /> 1 b.NON-REGULATED SHIPPER'S CERTIFICATION:I certify the materials described above on this form are not subject to federal reguta s for Tra portation or Dis al. <br /> •- Printed[Typed Name Month Day year <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> A P gnted(Typed Name +- ,A / Signature Month Day year <br /> 8 W`�'1 l�� t 1 I <br /> P <br /> O 18.T nsporter 2 Acknowledgement of Receipt of Materials <br /> R ri N me - Signature MonthD year <br /> T C1 Cphr <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 /> I <br /> T <br /> Y PrintedlT ped Name Signature Mo th Day ye <br /> �L <br /> ORIGINAL-RETURN TO GENERATOR FORM NO.01-90291(0312015} <br />