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LADING'/MA FEST 1.Shipper's US EPA ID No.(If Applicable) Document No 2.page 1 <br /> Of <br /> Name and Mailing Address_ADESA •: <br /> 18501- West Stiarsforo, <br /> ttn <br /> { f3T9h <br /> TRACY C 95377 <br /> ,lees Phone(. 1314-5374 <br /> ,isporter 1 Company Ie' 6.. US EPA ID Number A.Transporters Phone <br /> jransporter 2 Company"Name 8: S EPA ID Num er B.Transporters Phone <br /> s <br /> ).Designated Facility Name and Site Address 10. US EPA ID Number C.Facility's Phone <br /> EVS <br /> AEE"Y-KEEN CLOI <br /> 6880 S T} AVE, <br /> 11.Shipping Name and Description 12.Cont iners 13. 14. <br /> Total Unit <br /> HM No. Type Quantity wwoll <br /> a <br /> C -- EGUL TE L I QU I (VAC-01L WATER <br /> SLUDGE) (NOS' GIS GT/ CIT UBE A GLIL T ) TT G <br /> (NOT CA REGULATED) <br /> b. <br /> S <br /> H <br /> 1 c. , <br /> P <br /> P <br /> E <br /> 15.Special Handling Instruction and Additional Information A <br /> SKa "Y , <br /> ESA - Gf� rt Gat <br /> 16.510 1 Stanford. Ra <br /> Atte I hater° S h <br /> TCY CA5 --9708. <br /> 24 )• #1-800-468-1760 EMERGENCY ' (CH l K TE I) _ <br /> T ' -� 'S " G G " Y "TO RETAIN L T C ENSE SU Cf E" S � N CE- Y <br /> C T/PRFL. A. 3299/156097 Ca <br /> I O <br /> This is to cergly that the above-named materials are properly dassified,descdbed,packaged,marked and labeled and are in proper ` <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION:•_oondnion tocbans o lat on actor m to thea linable re ula6odsof If a De a tment of Trans ortetion. <br /> Printed/Typed,Name Month Day Year <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION;_I certify the materials describetl bove on this form are not subject to fed e` Iations for Transportation or Disposal <br /> • <br /> Prein4fTyped Name Month Day Year • <br /> .. �• <br /> T 17.Transporter 1 Acknowledgement 9#Receipt of Materials <br /> RIN r, <br /> P&4 A4— <br /> A Pdrited/Typed Name Signature Month Day Year <br /> S ` <br /> P ' <br /> 0Trans rte,2 Acknowle ement of R ipt of Materials <br /> R 1 .Printed/Typed Name Signature Month Day Year <br /> T. <br /> R <br /> 19.Discrepancy Indication.Space <br /> F <br /> A <br /> C }_ <br /> 1 <br /> 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 /> GENERATOR'S COPY FORM NO.01-90291'(r <br />