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ro <br />t <br />TRANSPORTER #1 FORM NO. 01-90291 (04111).': ' <br />SILL <br />1. Shipper's US EPA W No. (If Applicable) Document No. 2. Page 1 <br />OF LADING/MANIFESTt�of <br />3. Shippers Name and Mailing Address) (1 s'z % :. j..I i <br />o <br />till :�I'+.:(:c):ii:07-•1":t:.: f1h <br />4. Shipper's Phone ( <br />5. Transporter 1 Company Name 6, US EPA ID Number <br />A. Transporters Phone <br />7, 1 r'rnsportar 2 Company Name _ 8. US EPA ID Number <br />S. Transporters Phone <br />\. <br />9. Designated Facility Name and Site Address", 4 l7 T. 10. US EPA ID Number <br />C. Facility's Phone <br />3r>3 f1 t <br />� yr �:S <br />li�t..k:_i..l <br />1..1 i..li"`9f <br />! t >x:'+i€':i "i" I.3f?i :''r i:;?�,;:F;:F :t <br />:)�.•lh' ;ar4 _..;"ii'49Ci <br />11. Shipping Name and Description <br />12. Cont <br />Iners <br />13. <br />Tote[ <br />14. <br />Unit <br />#iM <br />No. <br />Type <br />Quantity <br />WWoi <br />:: <br />':b �{ (�} #._ tY 14. y. J�1 �L� �•>�`�� Vit. �.A�a 1 � �•� t:i6 °I <br />+¢ <br />fidl'1 <br />�,4 <br />t. <br />H <br />.I <br />c <br />P <br />P <br />E <br />R <br />d. <br />3 <br />15. Special Handling Instruction and Additional Information',`• <br />04(512776 3,70430 <br />' . r � :_a! yv .'c• :..s, . �� {' ..t �,� � {;2i'., �/ t/ __ �-sC•t2Sj ¢�r :EkG L <br />s'.' tiFt � {��, �. t'4 (..lt I�t.. t' § � s,l%f [t •�t�C:ti:.�'"`� /�4K.(.,._.j }J�^lewlti�.T i�«"r.S�;x?„�1SF��ti�t•�y <br />®'4 ?`F1� /, t 11.51 ��d-33.� die.i: rS t 1 ��..,;x� <br />.. , ar,4:%(• i .3 jl j .y .t ...t r t -:'j f.. I.:l r....s b1. <br />..'$.f �., ff F YfY�•i::. t -•.f rt[ ,. 4.�J� t / i. .f'..i .1. f.:fA <br />yy,f«f <br />f'?) (.. �5..#`S i:J •-:'tii`Si'::i }, f�F) Z.J a 3t ) <br />prow <br />16a. US DOT HAZARDOUS MATE IAtS SHIPPER'S CERTIFICATION: 'YM Is iW001Pmabove-motmd ortalsarap,opert s6ifea,aeacmaa,aa� seu.merieeanataceaeaaraareropot <br />rma wr as ro raaAohn'arirta o of Trans aaftn. <br />Rrinled/Typed Name Month Day Yaw <br />16b. NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on this form are eo sybject totedaral regulations for Transportatfon or Disposal. <br />®' <br />Pvntpdj,7:yppd Name t, , ant ay Year <br />(0,J t• v '4a4v m r <br />7 <br />R <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />A <br />Printedfryped Nameigna <br />a Monotfr� Day Year <br />w-.,. «�. <br />5 <br />�•;`.e, i <br />...:¢?w..,,,. .... :.% d • t..J <br />P <br />o <br />118, Transporter 2 Acknowledgement of Receipt of Materials <br />T <br />Printed/Typed Name <br />Signature Month Day Year <br />F <br />19. <br />Discrepancy indication Space f <br />- F <br />' <br />A <br />C <br />T ' L <br />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 />I <br />Y <br />P dfryped Na//me Sign(tuiMord D e <br />c"LL, <br />ro <br />t <br />TRANSPORTER #1 FORM NO. 01-90291 (04111).': ' <br />