Laserfiche WebLink
BILL OF LADING/MANIFEST 1.Shipper's US EPA ID No.(If Applicable) DocuF'rU, CM710,3Z 6 _ment No. 2.Page 1 <br /> of <br /> j E I <br /> 3.Shipper's Name and Mailing Address GIDE RII -,- Ci o l s:.(e n Bi-lt e <br /> 111501. West Stallfw-d R,0 <br /> 'YMICY CA, <br /> 4.Shipper's Phone( <br /> 5.Transporter 1 Compa"#e 6, US EPA ID Number A.Transporters Phone" <br /> '-=' FETYEL =EN SYS17VIS :l htC _ - ='_'-`'f,F--P o ntA <br /> 7.Transporter 2 o pany Nam 8. PA4@ Uur B.Transporters Phone <br /> 9.Designated Facility Name and Site Address TPCI 10. US EPA ID Number C.Facility's Phone <br /> THERM! 1,71-IJIDS INC, <br /> R'LfIR;KAMAS OR 9701,775--996t], OR@M 0121 -_'5j1 97 6 <br /> 11.Shipping Name and Description 12.Cont(Iners 13. 14. <br /> Total Unit <br /> HM No. Type Quantity WWol <br /> a' CRUSHED C SFUiC 01L, R'S R.TR M'3 <br /> MOT LK-33)?IST OR U aEPA RE•I21!1 .A T# )0) <br /> b <br /> S <br /> H <br /> C. <br /> P <br /> P <br /> E <br /> R d. <br /> 15.Special Handling Instruction and Additional Information $AA7 }^�[i } ✓ y{ <br /> FX SH d P# Lf?4, k r E-1 f f.•ti��1%�O Vi.f <br /> b:tan fot' d Rid <br /> tri'f�-:�.`�f•�Y r-':,a/i° 377--9708 a-�y€s1 p r <br /> ;R4 HR F MR RRI:-NCV 01-800­468-17(5121 ((."H / SK / TFT,) <br /> T,) <br /> r-ILI T H CIS "(16 NT--F1r.R " Fait TO RFTAIN R.IMNSED SLIB+ C AR RYER R (IR NE.f.F" ;SARA <br /> rJQT/R=r4,C0t , d3, ft p, ,-.:z1/,.3F�tt;3'3 S„ F; D. }, �+� <br /> A) N(:)NR= B) C:) I)) t i c/ —0 __ YYO <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION' 'This is to certify that he above-named materials are property classified,described,packaged,marked and labeled and are in proper <br /> condition for trans ortation accordin to theapplicable reulations of the Department of Transportation. <br /> Printed/Typed Name Month Day Year <br /> •• -. <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials describedabove on this form are not subject to federal regulations or r spo tion or Disposal. <br /> • Printed/Typed Name / Month Day Year a <br /> T' 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> A rintedfryped Name Sigreuv Month Day Year <br /> '�= 2 <br /> 0 18.Transporter 2 Acknowledgement of Recelfit of Materials <br /> R P' rf ed Name <br /> T YP Signature )) Month Day Year <br /> R <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 /> I <br /> T <br /> Y Printed/Typed Name \ Signature Month Day Year <br /> UAV <br /> ORIGINAL-RETURN TO GENERATOR FORM NO.01-90291(03/2015) <br />