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1.Shipper's US EPA ID No.(if Applicable) Document No. 12.Pa e <br /> BILL OF LADING/MANIFEST <br /> CAI-000346875 of <br /> 3.Shipper's Name and Mailing Address 18501. West Stanford Rd <br /> 10 Attn Gz mf-ie'1 Minhenr,y <br /> TRACY CA 95377 <br /> 209-814--5374 <br /> 4.Shiees Phone( ) <br /> 5.Transporter 1 Companyl�Ie"ne 6. US EPA ID Number A.Transporters Phone <br /> SAFETY--K,LjE' SYSTEMS INC TX FiOO !081.205. 972-265-2000 <br /> 7.Trff_tcter,2 c r r &rffS ENVIRONMENTAL S (a INC 4Ui�iPl�IST' ff2250 <br /> B.Transporter's Pho —792-5000 <br /> 9.Desi Hated Facilit Name and Site Address SJ 10. US EPA ID Number C.Facility's Phone <br /> C EAN FfO RBOR S 'SAN JOSE <br /> 1021. BERRYESSA ROAD <br /> SAN JOSE CA 95133 CAD0 x949431 t7_t 408-441--0962 <br /> 11.Shipping Name and Description 12.Containers 13. 14. <br /> Total Unit <br /> FH­Mj Noim. Type Quantity WtNol <br /> [ b. <br /> JUN3077 ENV I RONME NTALLY HAZARDOUS <br /> X SUBSTA ICErS, SOLID N. 0 Ro (MERCURY) , CF 2-4 0 F' <br /> 91 PG SII, UNIVER6AL WSTb-LAMP 2s <br /> UNIVERSAL_ WASTE LAMPSaC CF ® 9 '�► ' <br /> (FLUORESCENT LAMPS) <br /> S <br /> H <br /> C. <br /> P <br /> P <br /> CE ' <br /> R d <br /> 15.Special Handling Instruction and Additional Information _ <br /> SN, SH I P# ••i4 '"P� ADr�198 <br /> ADESA - Golden Gat _ <br /> 1.8501. Stanford Rd '22-4003 t19Attn Lester Sabo <br /> v <br /> TRACY CA 95377-9708 I <br /> ii)ERG#171 <br /> 24H EMERG 800-468-17G0(CH-•-SK -TFI ) -TRANS UTH TO RETAIN ADD' L .,AR IERS <br /> DO-T/PRFL Aa 8496346/1749045 Do 14815/156056 C. Da <br /> A) NONE E3) NONE C) D) <br /> 16x.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION' This Is to tarty that the above named mate els are properly ssified,described,packaged,marked end labeled and are in proper <br /> conditton for trans rtagoh sccordid to thea Ilcable re of the De artment of Trans ortation. <br /> Printed/Typed Name `f Month f D y 1 <br /> p( <br /> �6v <br /> TkAOA L4 Hal . i <br /> 16b.NON-REG LATED SHIPPER'S CERTIFICATION: I certify the materials describl above on this form are not subje eral regulations for Transportation or Disposal. <br /> •' C rinted/Typed Name Month Day Year � <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> A Printed/Typed Name Signature Q- Mofth a Y <br /> P <br /> o 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printed ped Name, Signature ( Month Day Year <br /> E O <br /> R ZL,�L 0z <br /> 19.Discrepancy Indication Space 1 j <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 ame. Signature Month Day Ye r <br /> :11 •1 <br /> FORM No.o1-sozsl(o3i2o15) <br /> ORIGINAL-RETURN TO GENERATOR <br />