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BILL QF LADING/MANIFEST 1 . Shipper's US EPA ID No. (if Applicable) p�c�rgdr} ` 2• Page 1 <br /> E:ALV10039"51� tau of '1 <br /> 3. Shipper's Name and Mailing Address Orchard V111113t 7 <br /> Cr650 N Macy" rthur Dr <br /> TRACY CA 915376; wE'12100 <br /> 4. Shipper's Phone { + g ) 8 -- 31 190 <br /> S. Transporter 1 Company Name 6. US EPA ID Number A. Transporter's Phone <br /> SAFETY --KLEEN SYSTEMS INCI - TX6000081005 • <br /> 7. Transporter 2 Company Name 8. US EPA ID Number B. Transporter's Phone <br /> 9. Designated Facility Name and Site Address EUS 10, US EPA ID Number C. Facility's Phone <br /> SAFETY -•KLl OF CAL. I FEIRN 1A <br /> 6880 SMITH AVEw <br /> NEWARK CA 945560 C, AD98088 41. t �f - 79 -���+�►ib <br /> 11 . Shipping Name and Description 12. Containers 13. 14. <br /> Total Unit <br /> HM No. Type Quantity wwol <br /> a NON-AIEGUL.ATE!? !, , IQUID ( VACmQTL. WATER <br /> 9t l) ( NOT USDOT / NQT USEPA RPISAJ A'tT r) ) TT G <br /> ( NOT CA REGULATRD ) C4p <br /> b. <br /> S <br /> H IF <br /> 1 c. <br /> P <br /> P <br /> E <br /> R d. <br /> ww <br /> 15. Special Handling Instruction and Additional Information <br /> Si{ zH IPIR 227106&45 OR 1121 <br /> e4H E'MERG# 8000- 468 1760 ( 1"� H — SK •' - TF I ) -••TRANS RUTH TO RETAIN ADD I L CARRIERS <br /> * 78604305* <br /> DOT / PRFL.. As 3299 / 156097 Ba I.'. • Da <br /> A ) NONE U ) C ) D ) <br /> 16a. USDOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: 'This Isla tbWythat " Above-namedMal edsbsrepropedyd 041dasuroaa, paewgod, Markedandtabetoaandareinproper <br /> mndaon forflans tion accord to thea icabb utatann of the Da admont of Trana afation. <br /> Printedrryped Name Month Day Year <br /> 16ba NON-REGULATED SHIPPER'S CERTIFICATION : 1 certify the materials described above on this form are not subject to federal nnforTfansporlattonor Disposal. <br /> - Prin{t�lTyped Name /j Month Day Year <br /> !� /. ( tea - � [ �ht :tft •Jz . . InFERMITIM <br /> T 17, Transporter 1 Acknowledgement of Receip f Materials <br /> R <br /> Snt /Typed Nab ; Signature ! ` l 1/e4on h Day Year <br /> P QX6 <br /> O 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printed/Typed ed NaSi nature <br /> T yp me 9 Month Day Year <br /> E <br /> R u <br /> 19. Discrepancy Indication Space �t R <br /> F <br /> I <br /> LLFacllitywneror Operator: Certification of receipt ofmaterials covered by this form exceptas noted in Item 19. <br /> IYyped Name Signature <br /> t _ Month Day Year <br /> iL <br /> i t t • I i I t ',. <br /> GENERATOR'S COPY FORM NO. 01 -9029 ► (0312015 <br />