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R7�� UJq I <br /> SHIPPING 1,Generator ID Number 2.Page 1 of 3 Emergency Response Phone 4.Shipmentiracking Number :z <br /> DOCUMENT CAL000401815 1 8775772669 408379070DOL <br /> _d 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Marshalls iffti22 Karshalls##M0122 <br /> z 2099527870 2203 Brand Canal ice, 2203 Grand Canal <br /> Generators PhonoPhone'. . <br /> 209952 Stockton, CA 95207„ 4- <br /> Stockton, CA 95207 <br /> _• <br /> 6.Transporter 1 Company Name U S.EPA ID Number <br /> a Stericycle Specialty Waste Solutio-Rs Inc MNS000110924 <br /> 7.7ransportar 2 Company Name US EPA ID Number <br /> f . <br /> S.Designated Factlily Namo and Site Address 91519 Lentury R v i ra 0ent a t US,EPA 10 Nrnmber <br /> 11855 White Rock Road <br /> Rancho Cordova, CA 95742 <br /> Facdl 's Phone: <br /> CAR0U210617 f <br /> 10.Conlamers 11.Tofal 12.Unit <br /> gb,U S.DOT Dos dpllon(including Proper Shipping Name,Hazard Class,l0 Mumbor,and Packing Group(it any)) y�'” <br /> ;x HM No Type QuaNily WI.NoI, .l <br /> 1. Batteries, Dry, Pealed, n. o= s (Alkaline I CF 0001,x• P <br /> �.r Batteries), <br /> z 2. Universal baste Consumer Electronics for, 2 DF 007.00 P <br /> Recycling x •' 4 <br /> 13:Special landlinglnstru�IlonsandAdditionallnfotmallon �„ 10233 tBOL Alkaline Batteries — Univer5r'],rl` wr1.fit0 ��a <br /> t °1 3 MCC •Universal Elect4roTlics) <br /> s, , <br /> 44.GENE�f1AiO i 5'CERTIFiCATIpN:I horobydeclare that the contents of this consignment ar©fuliy and accurately descdlied above by the proper shipping name,and are classified;packaged,•markiffind Iabotedlplacarded,and <br /> are In alt re'spodle iii prober oandlllon fof Iransporf according to applicable international and national goyernmenial regiifatfons. r <br /> 'tf .Gonbimtorsfolforuoui'��P.pnthtfllypodNamo Signature[jn be f of TJX' ' ,Month Day, Year <br /> •..i 15;,in1e aiwnah5h(ptrien ,,, " <br /> ❑Import to U.S. ❑Export fro'm U S. Pori of entrylexd <br /> Transporter SIL661b for ex orts onl : Date leaving U S' <br /> -W 16.TransporlprkknbivledJmontofRkeiptofMaterials <br /> Transporter ePrintedrryped Name SlgnatarA t * Month Day Year <br /> a. Jar"Lid Raf-ci e l 05 e�1 12017 <br /> 'Transporter 2P4ntedlTypedNamo Sfgnature Month Day Year <br /> 17.Discrepancy r <br /> 17a.Discrepancy Indication Space ❑Quanll 1:1TOE!, <br /> e <br /> '( 1Y yp ❑Residue El Partial Rejection ❑Full Rejection <br /> ShTLmenlTracklnq Number 1 <br /> P.Allordalo Facility(or Gonomtor) 1• ' U S.EPA iD Number <br /> r4 'Faoflity's Pliono; yl <br /> i <br /> w ,17c.Signaluro of Alternate Facilily(or Conerato"r) Month Day 'Year , i <br /> 1 Q.Designated Fadlily Ovmerar Dparalor?CemTication of recerpl o!materials covered bythe shipping document ezoept as noted in Item lla •_ � • - � `• <br /> ' Pnnto&ypod Name" <br /> c f Signature _ M�lh Oa bar, 1- <br /> QI69=8CC-o(ROV 5-11)'-�- ` 4G ;, K G✓~ f-J ,, <br /> .i ' pESIGNA'MIRACILITY'S COPY <br />