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z .<. <br /> i Sh!m 9 CEPA 1D No.(If Applicable) Document No. <br /> r + 2.Page 1 <br /> VZ5 of <br /> N � t <br /> t�15te li- US EPA ID Number A.Transporter's Phone <br /> ��etertip t <br /> 8EPAUS <br /> rID Number r ..., .. B.Transporter's hon Tra p rter s P e, "Q P <br /> e=st9�d It�Yf1at1e And Site Address g ' 10. US EPA ID Number C.Facility's Phone <br /> Y - *433. f 17Y$S i - <br /> w ,A <br /> 11 ;Sa•hippittg flame and Description 32-Containers To <br /> taI Unit <br /> No. Type Quantitffy�� WtNgI <br /> y„ <br /> Rei ry, <br /> '1 C <br /> ;p <br /> R. d <br /> 15.Special Handling In5tntction and Additional Information W3Ca7�7 �' <br /> $ <br /> 36a.I IS DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: Tn t is to-4fy that the above-narr�d materials are properly classftd,described,packaged,marked and labeled and are in proper <br /> oQndiSgn tof trans ortation accord' ,to the a 'tcabla regulations of the Oe rtment of Tws nolion.. <br /> Printed yped Name r Month Day Year <br /> VAO <br /> 16b.NOWREGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on this foYm aro not su 'ect federal regulations for Transportation or Disposal. <br /> PrintedlTyped Name Month Day Year T <br /> WPM <br /> 17.Transporter 1 Acknowledgement of Re0eipi of MaCeHal <br /> s <br /> PrintedlTyped Name Signature Month Day Year <br /> +� I C7 <br /> 113.Transporter 2 Acknowledgement of Receipt of Materials <br /> A P- ' yped Name r Signaturp-�,7 s Month Day Year <br /> t D1. . <br /> 59-DiswepohdY Indication Space <br /> R� <br /> Fedip p y <br /> ty;Juvner or C7 erator.Certification of receipt of materials covered b this form except as noted in Item 19. <br /> $nt�tediT3+pet-ala Signature Mon h Day Year <br /> dA <br /> J7 <br /> ; .....�-°'..�....,, <br /> ORIGINAL-RETURS <br /> FORM NO.01 <br /> NTOGENERATOR <br /> �os�r>bis� <br />