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BILL OF LADING/MANIFEST oc1.Shipper's US EPA ID No.(If Applicable) Dument No. 2.Page 1 <br /> —Cell 00117104.0996 - of <br /> 3.Shipper's Name and Mailing Address (St}.4' d) We b ilkr High <br /> 302 W Weber rive <br /> 8'rD014TSN 1[: i 9 R0.3,-,3124 <br /> 4.Shipper's Phone( �"•• - ) - 1 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporter's Phone <br /> FE�TV-••'sa1_FFEN SMEF _M IN!" 1 �F' � !�=` r-a• "���'w e�>�k,�,�w, f�i <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transporter's Phone <br /> 9.Designated Facility Name and Site Address 151F.2,5 l5 10• US EPA ID Number C.Facility's Phone <br /> S'tA!•' URT ENV I RIONM TN D`6W. N..N­G <br /> 679 SEAPORT BL.V F1 94067 CALOOO 4 e 4 a <br /> 11.Shipping Name and Description 12.Con finers 13. 1b <br /> Total Unit <br /> _HM-1 <br /> No. Type Quantity WtfVol <br /> a. _ , t..jcxj,,iD (le pp--on y Wiypv fir:"{yR <br /> SLiD(W) !NO_ 7DO NCI us9p&) �¢ <br /> ^i 3..Ly4P 5..,P'Y B :J •�•• �-�+ <br /> I <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 /> 115 a <br /> iFA- j .IN�>:'-RG* 600-466-1-760 i1 9a„`aro N i--'TRANS AUTN'•3'' 7T] RETtIIN ADD1 N- �:e���$�.Nw��S <br /> 3299/156097 Vii. C, D <br /> A) DONE ) C) Dt <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION •Thin iS to cerury that lhe above-Homed materiels are properly ctasslliod,deepibed,packaged,motkad and labeled Md are In proper <br /> conddion ret lrnns rtac <br /> nllon uwdl to theapplicable ule8ann of the i?a�Amenl d Tranz anon. <br /> Printed/Typed Name Month Day Year <br /> a• <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 /> N Month Da Year <br /> .- Printed/Type , V Name _ y. I <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials �r 1 <br /> A P i tId/Typed Nl e r '� Signature ° t Month Day, Year <br /> fir' I !l t- <br /> S � .�Nt N. '11� ��f✓`4 l��� �t:1_ i`� / . <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials s t <br /> R <br /> Printed/Typed Name Signature Month Day Year <br /> T <br /> F <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 /> GENERATOR'S COPY FORM NO.01-90291 (0312015) <br />