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BILL OF LADING/MANIFEST 1.Shipper's US EPA ID No.Of Applicable) Document No. 2.Page 1 <br /> CAL800.152055 of <br /> 3.Shipper's Name and Mailing Address JU rua i nnc <br /> 1415 W. Anmerson St. <br /> STOCKTON CA. 95206•--0000 <br /> 4.Shipper's Phone( 201-466-3L>82 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporter's Phone <br /> SAFETY-KLEEN SYSTEMS INC I . T X R000013 120-5 97a-265-2000 <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transporter's Phone <br /> 9.Designated Facility Name and Site Address EV17, 10. US EPA ID Number C.Facility's Phone <br /> SAFETY--KLEEN OF CALIFORNIA <br /> 6880 SMITH AVE. <br /> NEWARK CA 94560 G(M960887418 510-795-4400 <br /> 11.Shipping Name and Description 12.Containers 13. 14. <br /> Total Unit <br /> HM I No. Type Quantity Wt/Vol <br /> a. NON--REGULATED L.IGUID (VAC-OI4.,WATER <br /> SLUDGE) (NOT USDOT/NOT USEPA REGULATED) TT ; r <br /> (NOT CA REGULATED) <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 /> SK SHIP# P-26656917 JC 108 36 <br /> 24H EMERG# 800---468-1760(CH--SK--TFI )--TRANS AUTH TO RETAIN ADD'L CARRIERS <br /> 78106334 <br /> DOT./PRFL A. :3299/1` FDO97 H. C. D. <br /> A) NONE. B) C) D) <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: This is to certify that the above-named materials are properly classified,described,packaged,marked and labeled and are in proper <br /> condition for transportation according to the applicable regulations of the Department of Transportation. <br /> Printed/Typed Name • Month Day Year <br /> �• ., <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 Name Month Da Year <br /> t <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> A rinted/Typed Name Signature Month Day Year <br /> N <br /> P i OF <br /> O 18.Transpaher 2 Acknowledgement of Recei of Materials <br /> R Printed/Typed Name Signature T YP 9 Month Day Year <br /> E <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 /> 1 <br /> T <br /> Y Printed/Typed Name Signature Month Day Year <br /> GENERATOR'S COPY FORM NO.01-90291(03/2015) <br />