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a_ OF LADING/MANIFEST 1.Shipper's US EPA ID No.(If Applicable) Document No. 2,page 1 <br /> )" a f. c- a of <br /> 3.Shippers Name and Mailing Address AD - GO Golden Bate <br /> 185 71. West.. Stanford Rd <br /> Attn Samuel htlahenry <br /> TRACY CA 95377 <br /> 4.Shipper's Phone( <br /> 5.Transporter 1 Company Na 6. US EPA ID Number <br /> A.Transporter's Phone <br /> SAFE K 11-i <br /> �_,_ <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transporter's Phone <br /> CLEAN HARBORS ENV SVC INC. MAD039322250 781--792-51Z++Z0 <br /> 9.Designated Facility Name and Site Address SE�.�Er(Z1 3 10. US EPA ID Number <br /> SEn- POR T =ENV I RONMEN i_AL LLC <br /> C.Facility's Phone <br /> 679 SEAPORT BLVD <br /> REDWOOD CITY CA 94063 CAL000422492 800-321-1030 <br /> 11.Shipping Name and Description <br /> 12.Conti iners 13. 14. <br /> HM Total Unit <br /> No. Type quantify WWoI <br /> a. NON--REGULATED LIQUID (VAC--OIL WA"T"ER <br /> SLUDGE) (NOT USDOT/NOT USEPA 5HULATLD) TT G <br /> (NOT CA REGULATED) <br /> b. <br /> S <br /> H <br /> 1 <br /> C. <br /> P <br /> P <br /> E <br /> R d <br /> 15.Special Handling Instruction and Additional Information <br /> ADESA - Golden Gate SK SHIP## 2301726461. AD2171198 <br /> 18501. Stanford Rd <br /> Attn Lester Sabo I <br /> TRACY CA 95377--`708 i <br /> E4H EMERG## 1300--4G8-1760(CH•--SK-Tr I)--TRANS AUTH TO RETAIN ADD" L CARRIERS <br /> DOT/PRFL An 3E99/156097 Aa C. 1)o <br /> A) NONE B) C) D) <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 /> condition for trans ortaaon accordin to thea Ilcable re ulations of iha De artment of Trens ortalion. I <br /> Printed/Typed Name <br /> Month Day Year <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on this form are not subject to federal regulations for Transportatio or Disposal. <br /> Printedrfyped Na e <br /> Month Da Ye r'V, <br /> i <br /> R17.Transporter 1 Acknowledgement of Receipt of Materials <br /> N intedrryped Name Siture <br /> S g -t Month Day Year <br /> P- <br /> 0 18.Transpofter 2 Acknowledgement of Rec ipt of Materials <br /> T Printed/Typed Name <br /> Sigriatur@, Month Day Year <br /> E <br /> R }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 <br /> Month Day Year <br /> / <br /> 11R EMERGENCY#800-468-17.0 <br /> ORIGINAL-RETURN TO GENERATOR lzr)PRe Ki„ r,•t nnon+ ,� <br />