Laserfiche WebLink
I<: <br /> 1.Shippers US EPA ID No.(If Applicable) Document No. 2.page 1 <br /> BILL OF LADING/MANIFEST <br /> ofillit , <br /> 3.Shippers Name and Mailing Address N r t 2 a 1 d Foods <br /> c'Il 0 W it:h St <br /> CA 95366-2793 <br /> 4.Shipper's Phone( r`"i) <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporter's Phone <br /> 7.Transporter 2 Company Name a _.. 8. UtSt EPA ID Number r B.Transporter's Phone <br /> (. `.(—: �`"� )I-�l}'S .�s PKI .l'St�l�•� MENTAl... �JY! `?.� _.,. s.. •1 1G'`1 1 <br /> 9.Designated Facility Name and Site Address10. US EPA ID Number C.Facility's Phone <br /> S 3' <br /> BERRYF .'irl F:C:�€�7.7 . <br /> SAN OSE CA 95133 CsPD0 X949431 0 <br /> 11.Shipping Name and Description 12.Containers 13. 14. <br /> Total Unit <br /> HM No. Type Quantity Wt/Vol <br /> a UN r02 FAC)TTE�"RIES DRY CONTAINING <br /> I td1!'Ara`.:3I t_IM HYbRO' i i bE SOLID f I_ECTR I t "7,C'" <br /> `'TC1RAtE, F+, UNI:VE'RSAL_ WAS�'E=--BATTE RI'FS h. <br /> b. I <br /> UNIVERSAL_ WASTE LAMPS r <br /> S (FLUORESCENT LAMPS) 150 � I <br /> H <br /> <+ <br /> c. <br /> P <br /> P I <br /> E { <br /> R d. i <br /> `A <br /> 15.Special Handling Instruction and Additional Information j <br /> SK SH.EP# 225557106 NU10-796: <br /> 1) ERGffI34 <br /> 24 HR EMEAGENCY #1-800-468-1760 (CH / SK / TF I ) <br /> RUTH AS "AGENT- FOR" BY GEN TO DETAIN LICENSED SUB CARRIERS AS NECESSAR <br /> DOT/ 'RFL A. 7937190/1404196 1404196 I3. 14815/156056 C. D. <br /> A) NONE I?) NONE C;) D) <br /> d <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: 'This is to certify that the above-named materials are Property dassified,described,packaged,marked and labeled and are in proper <br /> —dilion for trans tion accordi to the applicable regulations of the DePartirrient of ran ortatio <br /> Printed/Typed Name y ,-� Month Day Year <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on this form are not subject to federal regulat s for Transpo tation or Disposal. <br /> Printed/Typed Name - <br /> Month Day Year <br /> T <br /> R 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> A Printed/Typed Name <br /> N Signature Month Day Year <br /> S <br /> l�P <br /> O 1 .Transporter 2 A_knoAr1ej_gem"e4 of Receipt of Materials <br /> R Printed/Typed Na <br /> t. / SlgnatUre Month Day Year <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <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 i f rName � Signature M th ay r <br /> 56 <br /> li*HR EMERGENCY#800-468-1760 <br /> fi <br /> ORIGINAL-RETURN TO GFNFRATOR FORM NO.01-90291(03/2015) <br />