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Shi <br /> BILL. OF LADING/MANIFEST 1. epees US EPA ID No.(IfApplicable) occu`mont�Njof 2.Page 1 <br /> of <br /> iik 9.Shipper's Name and Mailing Address RQ Lab Rubber Co. Vic. <br /> 8830 W Linne Rd <br /> TRACY CA 95304--9109 <br /> 4.Shipper's Phone 209r-836-0965 <br /> 5.Transporter 1 Company Name 6. US PPA ID Number A.Transporter's Phone <br /> --- SYSTEMS,. INC 197a7 -65 <br /> - <br /> 7.Transporter 2 Com an Narne 8. US EPA!D Number B.Transporter's Phone <br /> r,I-EPN i, ENVIRONMENTAL. B . INCIMAD0393eaa5o 781-792-5000 <br /> 9.Designated Facility Name and Site Address W1 10. US EPA ID Number C.Facility's Phone <br /> CLEAN HARBORS OF WILMINGTON LLC <br /> C <br /> 1737 EAST DrNNT STRE'E'T <br /> WILMINSTON CA 90744 r_AD044429835 310-835-9996 <br /> 11.Shipping Name and Description 12.Containers 13. 14. <br /> Tofal Unit <br /> NM No. Type Quantity Wttvol <br /> a. UN1950 AFROSOLS, (EACH NOT EXCECDING <br /> I L... L� 10I TY) , 2. 1, UNIVERSAL, WAST ­ ° DM <br /> AEROSOL. <br /> b. <br /> S <br /> H <br /> I c. <br /> P <br /> P <br /> E <br /> R d <br /> 15.Special Handling instruction and Additional Information <br /> SK SHIP# 225847301 - 1 4;a ' <br /> a4 HR EKE I G NCY *1-800-468-1760 (CH / SK / TFT) <br /> AUTH A "AGENT—FOR" BY BEI TO RETAIN LICEN9ED SUBCARRIERS AS NECESSAP <br /> D0T/PRF1_ A. 78,B6317/11875&5 B. C. 1). <br /> NOME ) I a) D) <br /> 16a.U5 DOT HAZARDOUS MAJERIALS SHIPP@R'S ERTIFICATION• ',is is to certify mat the aho-namedmateriaisare propetry crassitg t tLiee and an:in proper. <br /> condliionlor[ran5 ortatian:aocdrdin t+S.fh a-Ifra4le uiatio of. 6e a Moflrans, <br /> Printed/Typed Name pay Year <br /> 16b.NON-REGULATE SHIPPER' ERTIFICATION: I city the materials described atmia on Ns fonware not suN fede51. <br /> afians far Tr spoClaiton. Disposal, <br /> r- . <br /> yped Name , <br /> 1 - MonfRi Day ...yea" <br /> a <br /> li 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> A <br /> Printed/Typed Name <br /> ISignature Month Day Ye <br /> I; <br /> n 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> It <br /> d Name Sigre } <br /> Ft <br /> 19.Discrepancy indication Space <br /> f: <br /> A <br /> C: <br /> I• 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 /> �u tt <br /> ORIG IAII I =I 'IYI I TQ'G GENERATOR RpiTQI FORM NO.01-90291 (0312015] <br />