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Shipp:.r�USiE,P.,A it)No If Applicable) Document No. 2 page 1 <br /> NLL6F LADING/MANIFEST #" � a} c rr �a7 . of I. <br /> G-79 lik-MIPUR-1 <br /> 3.Shipper's Name and Mailing AddressIL Ifol We It ahfard Rd <br /> Q <br /> TRACY <br /> 4.Shipper's,Phone( )".•,< <br /> 5.Transporter 1 Company Name 6 US EPA ID Number A.Transporter's Phone <br /> 7.Transporter 2 Company Name 8. US EPA ID Number B.Transporter's Phone <br /> 9.Designateeydi iFacility Name <br /> g and Site <br /> r�Add�drrerssp� &SA P.60i5 10. US EPA ID Number C.Facility's Phone <br /> €;..NV d����8'+vi`ES':.9 o3 i AL G"�1—C' <br /> REDWOOD CITY cin <br /> 12.Containers 13. 14. <br /> 11.Shipping Name and Description Total Unit <br /> No. Type Quantity WtNot <br /> HM <br /> a; A MITER TT <br /> LUDUE) (NF <br /> (NOT CA REGULATF-10)1* <br /> b. <br /> S <br /> H <br /> C. <br /> P <br /> P <br /> E <br /> R7- <br /> 15.Special Handling Instruction and Additional InformationEJ <br /> 1 � (� <br /> 750 6 1 <br /> 650 <br /> TRACY C 9-S377-9708 <br /> 47 <br /> °41• E#��RED4 0-468— 76 (CH7 K�i"F'T 3.����t� �� �UTTO RETAIN �����,F� t Civ 2 R5 <br /> DOT/PiNFL A. -3P.99/156097 - C- Da <br /> NO ) �� ' <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION` This is to cert fythat the ebdve-named'metenals are propedyGass Fed,described,packaged marked and labeled and are in proper <br /> • condition for trans rtation accordin to thea Iicable regulations of the Department of Transportation. <br /> Printed/Typed Name • Month Day Year <br /> 16b.NON-REGULATED SHIPPER'S.CERTIFICATION: I certify the materials described above.on this form are not subject to fedgral regulations for Transportation or Disposal. . <br /> •_ 1f Month Day Year <br /> Printed/Typed Name <br /> �. R 17..Transporter 1 Acknowledgement of Receipt of Materials <br /> A rintedlTyped Name SigLure ' f /1) Month Day Year <br /> NIZZ I 10 Ito-71/ <br /> SD JR, s <br /> P <br /> . 18.Transpiyi r 2 Acknowledgement of Receipt of Materials. f <br /> i R Printed/Typed Name Signature ! Month Day Yr <br /> T <br /> E <br /> 2' <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 /> T ' <br /> Y Printed/Typed Name <br /> Signature Month Day Year <br /> I; r~ <br /> FORM NO 01-90291(03/20' <br /> I f,FNFRATOR'S COPY <br />