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BILL OF LADING/MANIFEST 1.Shipper's US EPA ID No.(If Applicable) cu <br /> DomntfYo. j2, Page 1 <br /> — 3 L of <br /> 3.Shipper's Name and Mailing Address American Honda Motor Co. <br /> 123 Val Dervi.n Pkwy <br /> STOCKTON CA 95206--4001 <br /> 6•-4001 <br /> Shipper's Phone( — <br /> ansporter 1 Company Name 6. US EPA ID Number A.Transporter's Phone <br /> 7.Transporter 2 Company Name 8. USA Ntimttes B.Transporters Phone v.. <br /> CLEAN HARBORS ENVIRONMENTAL S C. INC. MAD03932c:250 781-792-5000 <br /> 9.Designated Facility Name and Site Address Si 10. US EPA ID Number C.Facility's Phone <br /> CLEAN HARBORS SAN JOSE <br /> 1021 BERRYESSA ROAD <br /> SAN JOSE CA 9513; CADO59494310 408-441-0962 <br /> 11.Shipping Name and Description 12.Containers 13. 14. <br /> Total Unit <br /> HM No. Type Quantity wwol <br /> a' UN.3028 BATTERIES DRY, CONTAINING � tom=- <br /> X POTASSIUM HYDROXI$E SOLID ELECTRIC >� � P <br /> STORAGE, 8, UNIVERSAL WAStE-LiATTER I ES <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 /> 1)EFtG#154 SK SHIP# 225273347 AM 31' 2 <br /> 24 HR EME46ENCY #1-800-468-1780 (CH / SK / TFT) <br /> AUTH AS "AGENT-FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS P+IECES,r.-m <br /> DOT/PRFL A. 8268958/1634730 H. C. D. <br /> A) NONE N) C) D) <br /> 1,7�tow 00`9 oma <br /> 16a.USDOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION. � k�oa�Mjie,�t+sahavo•nanvpmrrwkareartipngdarmW.IMJOMd.95doW.IM(kaawoiaDN�Clw�pare•nprapar <br /> r,dann rm eo m a`. min. rfinenrar r <br /> Printecffyped Name f Mtxrrh Day Yn <br /> ��.«/ �• 1_5 <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I corttfy the materials described above on this form are not subject to federal regulations for Transportation or Disposal. <br /> PrintedfTyped Name Month Day Year <br /> MEN& <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> SN Pr [andlTypad na iSlgnetiJ '7 month /D� Yopi <br /> 4�- ! J;�[} <br /> P <br /> 0 18.Tran 2 Acknowledgemont of • t of Materials <br /> R Printed/Typed a I Signature Month Day Y <br /> EE ff� s , _ <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 /> v PrinleoLlrNd Name o Signature pe Monf!) Day Year <br /> r (/� a <br /> I .I <br /> ORIGINAL-RETURN TO GENERATOR FORM NO.01-90291 (0312015 <br />