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BILL`®F LADING/MANIFEST 1.Shipper's US EPA ID No.(If Applicable) Document No. 2.Page 1 <br /> of <br /> f <br /> 3.Shipper's Name and Mailing Address <br /> TRACY <br /> 4.Shipper's Phone <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporter's Phone <br /> F <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transporter's Phone <br /> f 9.Designated Facility Name and Site Address 10. US EPA ID Number C.Facility's Phone <br /> 11.Shipping Name and Description 12.Containers 13. 14. <br /> Total Unit <br /> HM No. Type Quantity Wt/Vol <br /> :j a <br /> I <br /> b <br /> : <br /> S <br /> H <br /> I c. <br /> P <br /> P f <br /> E C <br /> R d i <br /> 15.Special Handling Instruction and Additional Information <br /> SW 1C_3H1P# 229584192 RD 15429 <br /> vc La Vie`z=k:j <br /> f _"MERGA 8130-468-1760(CH--SK °`'F f )--TRANSAUTN 'TO E.TA I Nr�DD C. RR x EV <br /> tt^^11 78ry t <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION:87565 <br /> "This is to certify that the above-named materials are properly classified,described,packaged,marked and labeled and are in proper <br /> condition for trans oItion accordin to the applicable regulations of the Department of Trans ortation. <br /> Printed/Typed Name Month Day Year <br /> �s <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on this form are not subject to federal regulations for Transportation or Disposal. <br /> It. <br /> Printed/Typed Name Month Day Year <br /> R <br /> R17.Transporter 1 Acknowledgement of Receipt of Materials <br /> A Printed/Typed Name Signature Month Day Year <br /> N <br /> S <br /> P <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printed/Typed ed Name Si nature <br /> T yp 9 Month Day Year i <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 /> I � <br /> T <br /> Y Printed/Typed Name Signature Month Day Year <br /> 4 <br /> GENERATORS COPY FORM NO.01-90291(03/2015) <br /> f <br />