Laserfiche WebLink
BILL OF LADING/MANIFEST 1.shippers US EPA ID No.(If Applicable) Document No. 2.Page 1 <br /> �;t=#I_6100,34(-50-75.• 1..7ftE,.1. of <br /> 3.St per's Name and Mailing Address I-Al (A €e l) e <br /> M.l; f R Ititiff mi:-het��-•y <br /> TR'A C Y Cir) 9X5,"'77 <br /> 4.Shipper's Phone( <br /> 5.Transporter 1 Companyeme 6. US EPA ID Number A.Transporter's Phone <br /> SAFETY—#mss#. EEN' SYSTEMS INCA <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transporter's Phone <br /> 9.Designated Facility Name and Site Address E-"V(7, 10. US EPA ID Number C.Facility's Phone <br /> SAFETY—KI-FEN OF C'ALIFORNI-A <br /> 6780 Ca :CTM AVE. <br /> NEWARK CA 94560 CAD980887418 <br /> 11.Shipping Name and Description 12.Containers 13. 14. <br /> HM No. Type QTotal Wt%it <br /> a. NON 3-J#fR#il_s"T T3 LTC�UP) (VA •---CML_ WATER <br /> OI <br /> SLUDCBE) (NOT LI,SDOTMOT L#SC'P I4! C#_i#._ T e.# ? TT (� <br /> MOT CA RE GUL-ATED) <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 <br /> POE'St-2) — Golden Gate CTS t1IEII-°II c.':5Z; 1t 191 t` )S'01 `'tfI <br /> 11603. Stanford Rd <br /> TRACY CA 9,r5j37*7­537r/jA <br /> 24H EMERG# 800-468--1.7(50 (C<I-1--•SK---1"F r )---TRANS nLJ T E•# T13 RET'A[N AJ)D9 L C ARRTERS <br /> DCCTfPREL AA 3299/156097 jL C 'n. I w <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION- 'This is to certify that the above-named materials are property classified,described,packaged,marked and labeled and are in proper <br /> Printed/Typed Name cenditiofor trans n rtation accordin tothseEplic,ablarepulabonsofthe De artment of Trans ortalion. <br /> Month Day Year <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on this form are not subject to fader talions for Transportation or Disposal <br /> •- Printed/T ed Name <br /> KG.t]/ � Mont Day Year <br /> Wa11. <br /> R 17.Transporter 1 Acknowledgement of Rec pt of Materials <br /> SPrint\f(/Typed Na a Signature <br /> S \\ Mon Da Year <br /> P N A I&, f I <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> T Printed/Typed Name <br /> Signature <br /> E `"' Month Day Year <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <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 Signatur <br /> Month Da . Year <br /> ( ©•1 2 <br /> :rr ,1q.15ilill <br /> ORIGINAL-RETURN TO GENERATOR FORM NO.01-909A1 fn tigniR� <br />