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1 BILL OF LADING/MANIFEST I.Shipper's US EPA 10 No.(If Applicable) Document No. <br /> 1 OWPOIFI 1, <br /> 3,Shipper's Name and Mailing Add gss V r., <br /> 95e-05-4713 <br /> 4,Shipper's Phone( <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporter's Phone <br /> i"AFETY-KI-EEN 6YS-('E:MV 1,N;; <br /> NTAL SC W <br /> S�P6 8,jNYjt. �;,P B.Transporter's Phony <br /> fI ..UM <br /> 9,Designated Facility Name and Site Address f3t. 10 US EPA ID Number C.Far.0ity's Phone <br /> Ct-FANHARBORS UF 81ITTONWILLOW <br /> F500 LOKE RN ROAD <br /> 8UTTDNWTU-0W CA 6;F.—6;�xoo <br /> 11 Shipping Name and Description 12. <br /> Conts mars 13, 14, <br /> HM Total Unit <br /> 7 N/C47 N-SN DOT REGULATED MATE R I At, No. TypeQuantity wtrvol <br /> (CONTAINS UREW , N/A 's <br /> H <br /> I C. <br /> P <br /> P <br /> E <br /> R 7 <br /> 15.—Special—Handling Instfuct—ionand Additional Information <br /> 3K S111 9-11 94,17 <br /> a4H FAER6# 600-460-1760(L.'H-SK-TFI )-T InSPL=11'�ITU RETAIN ADVIL CARRIERS <br /> D(TF/PRVL A. 8470765117eS262 3. -_ 0. <br /> 0) NUNF B) C) D) <br /> 14.US DOT HAZARDOUS MATERIALS SHfpprzR,s cERTWICATION: dw,q-4,pa upas,"wrked&,4 wbawo ano are A wopw <br /> xP:in fo, iVN <br /> T�- IQ�-01141,�—t. <br /> � f 4n..2f 10 <br /> Printedfryped Name 1— <br /> mooth Day y0ar <br /> � <br /> 16b.NOW-REGULATED SHIPPERS CERTIFICATION: i Ux*0,01 Materials doic-000 aivve on.tlttF twm tz f6d4ral fur Tr stroesation or Dispo"L <br /> • Printpd[Typed Name <br /> rt J man'th Day Yaw <br /> T <br /> R 17.Transporter I Acknowledgen-tent of Receipt of Materials <br /> A rinte&Typed Nam "wth Day Year <br /> N 4-1 <br /> P?Vvie- <br /> 0 18 Transporter 2 Atknowledgement of Receipt otpaterials <br /> PrfnfedfTyped Name nature Month Day Vow <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L 20 Fa6lity Mvnar or Operate ri Certification of receipt of materials covered by this form except as noted in item 19, <br /> I <br /> T <br /> Y Printed/Typed Name Signature MONA Do), roar <br /> f'E:t,l;=DATf\01Q (1r)PV FORM NO.01-90291(031201 <br />