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1133 <br /> 11 3 3 7 7 9 WORK ORDER NO. <br /> DOCUMENT NO. ST1,71AIGHT BILL OF LADING <br /> TRANSPORTER 1 _ _ VEHICLE ID# <br /> EPA ID# TRANS. 1 PHONE. <br /> TRANSPORTER 2 _ ____ VEHICLE ID# <br /> EPA ID # TRANS. 2 PHONE <br /> DIaSIGNATED FACILITY SHIPPER <br /> FACILITY EPA ID # SHIPPER EPA ID # <br /> ADDRESS ADDRESS <br /> CITY STATE ZIP CITY STATE ZIP <br /> CONTAINERS TOTAL UNIT <br /> NO. & SIZE TYPE HM DESCRIPTION OF MATERIALS (QUANTITY WT/VOL <br /> A.l3ia:U�k,f'lil ItHIL:a.1akY,i,(}�iilrTiihi+w 1+cisN:rrlllii i i1'IiNI}Xls.i: <br /> B. <br /> C. <br /> D. <br /> E. <br /> F. <br /> G. <br /> H. <br /> SPECIAL HANDLING INSTRUCTIONS , iii,:.,-!'l.�ti�lis_ r:q;;i,ur:ir• :,dais �; NERn�lar�:a+:t: us►u+j:��;. <br /> n.i i- iiLiti ii_Ii+Li_t•.ea si � i i —_ �i•.141 ci+o isi-:-�IItiT'�:i.��• <br /> SHIPPERS CERTIFICATION: This is to certify that the above named materials are properly classified, <br /> described, packaged, marked and labeled and are in proper condition for transportation according to <br /> the applicable regulations of the Department of Transportation. <br /> PRINT SIGN DATE <br /> SHIPPER <br /> PRINT SIGN DATE <br /> TRANSPORTER -1 <br /> PRINT SIGN DATE <br /> TRANSPORTER 2 <br /> PRINT SIGN DATE <br /> RECEIVED BY <br /> CHI 107 <br />