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BILL OF LADING/MANIFEST 1. Shipper's US EPA ID No, (if Applicable) Document No <br />2. Page 1 <br />3. Shipper's Name and Mailing Address DEPAR-1 MENT <br />OF FISH AND GAME- <br />of <br />I_::. J <br />`800 WIRTH <br />MCINTIRE ROAD <br />CH-EMENTS <br />F-P <br />4. Shipper's Phone t7 <br />5, Transporter I Company Name <br />6. US EPA ID Number <br />A. Transporters Phone <br />.-'Ail_ETY--KLF-­EN SYSTE MS. I NC. <br />I TX-ROVI-01050930 <br />9 _7 F_ <br />t 171 . _; <br />7. Transporter 2 Company Name <br />8. US EPA ID Numberr's <br />B. Transp Phone <br />9. Designated Facility Name and Site Address 0 —1 <br />10, US EPA ID Number <br />C. Facility's Phone <br />COOPER CRE'E[./, RC,'W'm <br />(1. <br />E� N T 01 N' r X <br />TXDQ1'_7!b0_.J,371 <br />11. Shipping Name and Description <br />12. Containers <br />13- <br />14. <br />HM <br />No. <br />I Type <br />Total <br />Quantity <br />Unit <br />WtIvol <br />a. <br />7 <br />RE.SIDUE-1: LPI ST CONTnINE".IJ <br />G. iLAT <br />Q/ 61- 41vd L& <br />I <br />OTVAT/tn C"d, <br />—L/ <br />XM <br />1-/60 <br />P <br />b. <br />S <br />H <br />I <br />C. <br />P <br />P <br />E <br />R <br />T <br />15. Special Handling Instruction and Additional Information <br />SK SHIP.4# 2.0199ZL954 <br />0 _3 0 JR <br />i..4 HR EMERGENCY #1-800-46.8-1.7630 (S, FET"/—VL:. <br />.. A ..rr-EN <br />941 —8 <br />A) NONE <br />SK PUTH'D TO USE SUBSEQUENT CARRIERS: 41078, 41471, <br />61681, Bi.-RT39, 8,53SE19 <br />DOT/PRFL A. 1617/15016':) B. <br />C, n D. <br />"This is to certify that the above-named materials are properly classified, described, packaged, marked and labeled and are in proper <br />16a. US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: condition for translortation accordin 10 the applicable regulations of the Department of Transportation. <br />Printed/Typed Name <br />Month Day <br />Year <br />16b. NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on this form are not subject to fedepl regulations for ransportation or Disposal. <br />• <br />Printed/Typed NamMonth <br />Da <br />Year <br />It C_ <br />%2E % <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />••1 <br />9 <br />R <br />A <br />P d/Typed Name <br />Signature <br />Month D <br />y <br />P <br />) <br />VD <br />0 <br />R <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />T <br />E <br />Printed/Typed Name <br />Signature <br />Month Day <br />ye I <br />R <br />"1_"1 <br />F4 <br />19. Discrepa )cy Indication Space <br />A <br />C <br />I <br />1 <br />Lffffer <br />or Operator: Certification of receipt of materials covered by this form except as noted in Item 19. <br />T <br />