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BILL OF LADING/MANIFEST I Sl US EPA iDN.. <br /> 3.Shipp'(,Name 7� call Document I <br /> ame and A� � l! iAddress� 1 —-­ ill ill 1 ; ­1 . 1 :1. 2.Page I <br /> fic <br /> �7 <br /> of <br /> 4.Shipper's Phone( <br /> 5.Transporter Ior, <br /> Y narNam, <br /> 7,Transporter 2 Company Name 6, U I S E PA 11)Number A.Transporter,s Ph... <br /> 9.Desig"l 8. US EPA ID ame antl Srte Address Number <br /> B.Transporter's <br /> Phone <br /> 10. US EPA ID Number <br /> C.Facility's Phone <br /> 11 Shipping Name and Description <br /> HM <br /> WN Si 12.Contain <br /> 13, 14, <br /> No.. Total <br /> 07/W-1 pe Quantity unit <br /> PD r� wwol <br /> S <br /> H <br /> I C. <br /> P <br /> P <br /> E <br /> d.. <br /> 15,Special Handling Instruction <br /> Information <br /> i" <br /> 4 6-r�N f <br /> AU-1-H 1, t41 --two I!pit <br /> �"70 N I"- F.'Cj p4 -I F{ <br /> 1-T J'I <br /> f4v GEN rt, REr <br /> -r,)I N <br /> W—r <br /> Nll f. <br /> 16a.US DOT HAZARD: US ii� <br /> Printed/Typed N meTERIALS i E l;!I fill C <br /> meantconawon l.heda 'pn.any <br /> ma,:ad and labeled era In P".. <br /> 16b.NON-REGULATED <br /> Prin d/TYppd N meCERTIFICATION: I Carl the materials dMonth <br /> T 1.1 1�: as-b.d above n th'a f01r,are not s.bjeet tO federal 0-Y Y.. <br /> R 17.Transporter I Ark o regulations for Transportation or Disposal. <br /> cei <br /> N note, Yped.Na )t Of Material, <br /> A • Month Year S k I — I, <br /> P l Slgnqtu6 <br /> 18 Trans ter 2 Ackn <br /> rter 2 Aekn <br /> terials <br /> -�ent of�Rec., t � <br /> Pnntedl Namele:dq:e�m Me <br /> Dey Year <br /> Signature <br /> 19.Discrepancy Indication Space <br /> Month Day Year <br /> 20.FaciltyOwner or Operator:Certification of deral of me <br /> terials coveretl>;y(his <br /> Pnntedl Name 1 except as noted in its 19 <br /> Signature <br /> Month DaY Y.. <br /> GENERATOR'S Copy <br />