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1.Shipper's US EPA ID No.(If Applicable) Document No. 2•Page 1 <br /> Ql� yF LADING/MANIFEST <br /> '441"' A of �. <br /> 3.Shippers Name and Mailing Address -Gamey) 175to <br /> ION01 VSFrt Stanford Rd <br /> Attuawttllpei mr-heytvTRACY CA 95377 <br /> '°{ <br /> 4.Shipper's Phone( ;' 1..f,14-5-374 <br /> 5.Transporter 1 Com 1ny me 6. US EPA ID Number A.Transporter's Phone <br /> S F'F;µi Y w N SYSTEMS' .a NC T-YR008 1-205 <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transporters Ph6ne <br /> 9.Designated Facility Name and Site Address ( 10. US EPA ID Number C.Facility's Phone <br /> 11 F E'TY- . €� <br /> N , �F ALAF ORNIA <br /> t Gagg iT14 AVE.ARR A 94,560 _ <br /> .11.Shipping Name and Description 12.Containers 13. 14 <br /> Total Unit <br /> —H-M­j No. I Type Quantity Wt/vol <br /> a. 1'UN— mOUL ED LIQUID (WIC-113 11-, WAT"E'P.. <br /> St <br /> TSE Ei 11 "$ 1�IEFr Chi ;tGli. 1 ' i h t <br /> ( T E1. 1�FTE'1 ? <br /> b. <br /> S <br /> H <br /> c <br /> P <br /> P <br /> E <br /> R tl. <br /> f <br /> 15.Special Handling'Instruction and Additional Information <br /> / HI-,PY ' -t¢i56 t r I��b <br /> 60 <br /> r f, tif ard Rd <br /> TRACY CA 95377--9708 <br /> 1� � t <br /> EMERBW 000-468-1760(CH-SK-TIF I ) A1,1` H TO F P-V1"AI N i-W) ' li- tnu,P,�.raR <br /> T/PRF-T-. A. :32--9� 1 e56 0 9 7 A. rl. F) <br /> NONE 1) G 1 <br /> `This is to certify that the above-named materials are property classified,described,packaged,marked and labeled and are in proper <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: applicable " <br /> condition for transportation accordin to the a licable re ulations of the De artment of Trans ortation. <br /> Printedfi'yped Name Month Day Year <br /> so <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 /> •' <br /> Printed/Typedf pe r Mo Day Ye <br /> } # F' t'1 <br /> R 17.Transporter 1 Acknowledgement of Receipt of Materials 4,1 <br /> Arinted/Typed Name Si` ture Mo Day Ye r <br /> N <br /> S t . <br /> P <br /> 0 18.TransoclIter 2 Acknowledgement of Rece t of Materials <br /> R Printed/Typed Name Signature Month Day Year m <br /> T <br /> E <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 /> T' <br /> Y Printed/Type d`Name Signature Month bay Year <br /> GENERATOR'S COPY <br /> 'FORM NO.01'-90291(03/2'015) <br />