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1.Shipper's US EPA ID No.(if Applicable) Document No. 2.Page 1 <br /> BILL OF LADING/MANIFEST of <br /> 3.Shipper's Name and Mailing Address 0 e c a n <br /> - Hond--A Wo,t a; C r", <br /> U.23 PkWY <br /> TOCKTON L1:11 9`5P-06, -4+801 <br /> '`,Shipper's Phone IiAC4) <br /> Transporter i Company Name 6. US EPA ID Number A.Transporter's Phone <br /> 8. Ua MrIA lu rquAtwr B.Transporterrj,�� <br /> 7.Tr.nZr6r t T <br /> UEAN HARBORS ENVIRONMENTAL 761-798--5000 <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number C.Facility's Phone <br /> HARBOW3 SAN JQSE <br /> 61---RRYFS'GA ROW) <br /> 17"AN J(-CIE CA 95133 <br /> 408-441-0968 <br /> 11.Shipping Name and Description 12,Containers 13. 14. <br /> Total Unit <br /> HM No. Type Quantity Wt/Vol <br /> a. ON-301128 SAT TE'RIE" DRY CONrAINING <br /> X POT'ARSIUPI HYDRUX76E (RW.TD FLEGTP�c <br /> STORAOF, 8, UNIVERSOL <br /> b. <br /> I <br /> S <br /> H <br /> I G. <br /> P <br /> P <br /> E <br /> R <br /> d. <br /> 15.Special Handling Instruction and Additional Information �".T?'C':`77)347 AM23152 <br /> # &,, / TFI ) <br /> ---S ...4F -I <br /> —4 HR F-�ME 1, -00 �S 50 (Cle I S <br /> AUTH A� "(AWNT—FOR" BY GF:'IN ril Rs�.'TAtN 11-.TCV.N9F--D 'GUB CARRIERS AS NECE'7'."IR' <br /> DOT/FIRFL A. 82689---'8/1634730 H. f", 1). <br /> A) NONE 6) C) D5' <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: <br /> "The is 1.Cartly Ural the abort nomad mrdorWs are properly fb0fled. <br /> =..pa, ,markwln[l d.and tntial*d and are in proper <br /> , a <br /> Printed/Typed Name J Month Day Year <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 /> Printed/Typed NameMonth Day Year <br /> R.M <br /> T . M. I . <br /> 'r 17.Transporter I Acknowledgement of Receipt of Materials <br /> R <br /> A PriffledlTyped Name Signature Month Day year <br /> N <br /> S <br /> P <br /> 0 18.Tvanspo <br /> 2 Acknowledgement of Receipt of Materials <br /> Signature Month Day Year <br /> TR R <br /> E Printed/Typed Name <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I I <br /> L <br /> 20.Facility Owner or Operator:Certification of receipt of materials covered by this form except as noted in Item 19. <br /> Printed/Typed Name Signature Month Day Year <br /> GENERATOR'S COPY FORM NO.01-90291 (03/2015) <br />