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BIl 'OF LADING/MANIFEST 1.Shipper's US EPA ID No.(If Applicable) Document No. 2.Page 1 <br /> CAL 3. �.�. 1,.5� of <br /> 3:Shipper's Name and Mailing Address ADESA - Ga 1 den Gate <br /> 18501 West Stanford Rd <br /> Attn Samuel Mehenry <br /> TRACY CA 95377 <br /> 4.Shipper's Phone <br /> 5.Transporter 1 Company'e Zine 6. US EPA ID Number A.Transporter's Phone <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transporter's Phone <br /> CLEAN HARBORS ENVIRONMENTAL SVP XNC, MAD039322250. 781-792-5000 <br /> 9.Designated Facility Name and Site Address SAL 10. US EPA ID Number C.Facility's Phone <br /> 5090 8Af=4Y-A BI=B 125 SSE 'CR So 3 441 b <br /> �nC1.AGG19M11iS _x. 51,1105 __... <br /> o S o <br /> 11.Shipping Name and Description 12.Containers 13. 14. <br /> Total Unit <br /> HM 1 No. Type QuaWity wt/vol <br /> a' RUSHED USED OIL. FILTERS <br /> (NOT USDOT OR USEAA REGULATED) 2 DM -'j O U R <br /> b. <br /> S <br /> H <br /> 1 c. <br /> P <br /> P <br /> E <br /> R d. <br /> 15.Special Handling Instruction and Additional Information ??373(r 7 21 <br /> t <br /> ADESA - Golden Gate SK SHIP'# AD20198 <br /> 18501. Stanford Rd <br /> Attn Safet Sam <br /> TRACY CA 9377-5708 <br /> 24 HR EMERGENCY #1-800--488--1760 (SK / TFI) <br /> AUTH AS "AGENT-FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY <br /> DOT/RRFL A. 7873331/158033, B. C. D. <br /> A) NONE B) C) D) <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION "This is to certify that the above-named materials am properly raasstned,described,packaged,marked and labeled and are in proper <br /> condition for trans rtationaecordln tothe a licable re ulations of the <br /> ,.,art <br /> of Trans oriatton. <br /> Printed/Typed Name Month Day Year <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on this to are not subject to f al r uletlo s for Transportation or Disposal. <br /> •' Printed/Typed Name Month Day Year <br /> T 17.Transporter Acknowledgeme of Receipt of Materials <br /> R <br /> A Printed/Typed Name Signatur Month Day Year <br /> S 1 .01 <br /> P J 1 1-2 <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials a <br /> R <br /> TRy d ame � Sig . MonteYear" <br /> R CIE <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <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 /> amu` 1O 3I l7 <br /> ORIGINAL-RETURN TO GENERATOR ,,,,_ -Q I, / FORM NO.01-90291(03/2015) <br />