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BILL OF LADING/MANIFEST 1.Shipper's US EPA ID No.(If Applicable) Document No. 2.Page 1 <br /> In - of <br /> 3.Shipper's Name and Mailing Address TY"c"1cy Honda <br /> ida <br /> ;3450 Auto Plaza Pkwy <br /> TRACY CA 95M-0000 <br /> 4.Shipper's Phone( jr�"-j• �}�� <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporter's Phone <br /> INC <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transporter's Phone <br /> CLEAN H14R.BOFt..S ENV SVC :LNC. 'Nl 7�c^rt�2l�tt�! <br /> 9.Designated Facility Name and Site Address SJ 10. US EPA ID Number C.Facility's Phone <br /> C:Lke(-111 r1ORBORS SAN [)SE <br /> 1021 BERRYE SSA ROAD <br /> SAN JOSE CA 95133 33 CAD059494310 408--441-,"7 96 <br /> 11.Shipping Name and Description 11.Containers 13. 14. <br /> Total Unit <br /> HM 1 No. Type Quantity Wt/Vol <br /> a. l.N2795 BATTERIES WET FILLED WITH ALKALI, <br /> 8 (L NJ OERSAL_ WAStE:: ATTER IE ) <br /> (ERG#154) <br /> S � . i <br /> I C. fit! <br /> P N Q N DOT Rf�.GUL ATED tMATE''R.IAL., . <br /> P UNIVIkRSAL WASTEf LAMP <br /> E �. t <br /> R d. <br /> i <br /> 15.Special Handling Instruction and Additional Information <br /> SK 13HIP# 23;2584218 TR 34107 <br /> 1)F R13##i 54 <br /> 24N -EMEOG4 800--461--176+ (C;H-SK-TF'I)--TRANS AUTH TO RETAIN ADD° i._ CARRIERS <br /> DOT/PRF'L A. 8291559/15€ 606 . � ­410811MM475 C. 8689106/!B866aa D. <br /> A) NONE B) NONE C) NONE D) <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: "This is to certi y that the above-named materials are properly classifetl,tlescri me packaged,marked and labeled and are in proper <br /> condition for trans ortal,,n accordin to theapplicable re ulalions of the De arlmenl of Trans ortation. <br /> Printed/Typed Name/ r� r•- �y I I Month Day Year <br /> me <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 Day Year <br /> E <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> N <br /> A Printed/Typed Name Signature' Month Day Year <br /> P / t` <br /> 0 18.Transporter 2 Acknowledgement of Receipt 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 />