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BILL OF LADING/MANIFEST 1.Shippers US EPA ID No.(If Applicable) Document No 2.page 1 <br /> of <br /> [ShippeesPhone( <br /> Shipper's Name and Mailing AddressJxb Hunt — StOCd <br /> 660 Loomis Rd <br /> STOCKTON CA 95205-0000 <br /> 209-1235--1365 <br /> S.Transporter 1 Company Name 6. US EPA ID Number A.Transporters Phone <br /> P_ <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transporters Phone <br /> 9.Designated Facility Name and Site Address EVG 10. US EPA ID Number C.Facility's Phone <br /> IY—Y,LEEN OF CALIFORNIA <br /> E, SMITH AVE. <br /> NLWARK CA 94560 CAD980887418 510-795-4400 <br /> 11.Shipping Name and Description 12.Comb iners 1 13. 14. <br /> Total Unit <br /> HM No. Type Quantity WWoI <br /> a' ON—REGULATED LIQUID (VAC—OIL WATER <br /> LUDGE) (NOT USDOT/NOT USEPA- REGULATILD) TT <br /> (NOT CA REGULATED) <br /> b. <br /> S <br /> H <br /> I c. <br /> P <br /> P <br /> E <br /> R 7- <br /> 15.Special Handling Instruction and Additional Information �„— <br /> F: SH I P l# 'r'�__ ,,,r�1 SS9793 <br /> —_fir -HR EMERGENCY #k1--800-4j-11760 (SI{_/ T1 I7 <br /> AUTH AS "AGENT—FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS P <br /> ***75813331*** <br /> i•J <br /> DOT/PRFL A. 3299/156097 B. C. D. <br /> A) NONE B) C) D) <br /> 5& t (gool l4q &q <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: 7.bel.�ppahiy mzanne amo reams Marble are popady daadfled.Macdbod.pa=waaad.man<ed and iabetad and are in proper <br /> mminoo rpro-ans rtabon amordi to Mea linable oiepipna aue oe admootorrraha pion. <br /> Pdnted/ryped Name <br /> Month Day Year <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on this forth are not subject to federal regulations for Transportation or Disposal. <br /> • Prin yped Nam Month Day Year 0 <br /> •— <br /> REM x r <br /> • T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> A nted/ryped Name Si ture Month Day Ye <br /> N <br /> 6 e c �: � <br /> P <br /> O 1B.Trans r2Acknowledgementof Receipt Materials <br /> T Printed/Typed Name Signature <br /> Month Day Year <br /> E <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 Pqg ed Signature Month Day Yeer <br /> L <br /> 24 HR EMERGENCY# <br /> 800-468-1760 <br /> ORIGINAL-RETURN TO GENERATOR FORM NO.01-90291(03/201; <br />