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SHIPPING 1.Generator ID Number 2-Page 1 of 1 3.Emergency Response Phone 4.ShipmentTracking Number <br /> DOCUMENT -- <br /> f ��-`- � i i�r R r'Rf r1 <br /> 5.Generator's Name and Mailing Address Generator's She Address(if different than mailing address) <br /> L''31'Irt % Lo,dy I-!et-I<-_ 1510 13 t l:Di:- ltet-}..-iY151C <br /> 2094_`29339: 4950 PACIFIC AVE, t-lEBER TOI;IN ALL// SPACE 4950 PACIFIC FIVE <br /> Generator's Phone.'.: Aq 'T —Or N4 P =t—t+1 <br /> 8.Transporter i GompAnyNariie U.S.EPA ID Number <br /> 1r so-cia?ty Waste Solutions Inc MNS000 110924 <br /> T T " Z "Na' U.S.EPA ID Number <br /> A 01 <br /> 0- <br /> Site Add— <br /> -SdaAddress 21st Cen tsry EI`4i`Is LLC U-S.EPA ID Number <br /> 0-095 Newlands Dr. East <br /> Fernley, NV 89408 <br /> t s as sPiwne: 77557527811 <br /> a10.Containers i1.Total 12.U <br /> gb.U.S-DOT Description[mctuding Proper Shipping Name,Hazard Class,ID Number,and Packing Group(if any)) n <br /> NM-- No. Type Quantity WIJVoI. <br /> onsfscter Electronics for Recycling 1 CF 00007 P <br /> xe <br /> tea- _ �• <br /> v.. <br /> �3 riling Instructions and Additional information 1, 11.1131(ConEu,mer ElectrGnies for Recycle-) <br /> � TDA'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described by the proper slipping ahe,and are classified,packaged,marked and tabele&p!acarded,and <br /> �respects in proper condition for <br /> P Pe transport according to applicable international and national governmental regulaRo . <br /> �- carK <br /> sferot s Printed/Typed Name Signatu RI_ rea l f of 1 m l t e Month Day Year <br /> i 9 maffonalS ments <br /> ❑Import to U.S. - ❑Export from U.S. Port of en exit: <br /> ,77 6iter nature for exports a Dat Ie U.S.: <br /> f Foifer Adorowledgment of Receipt of Materials <br /> TCarlspcxter 1 Prioted/Tylit!d Name <br /> ignature Month Day Year Y <br /> m iT tr Mack WE <br /> T rint yped Namei_ <br /> Signa Month Day `Year <br /> Lev I <br /> 17 scieparcy <br /> I Discfepansy Ind cation Space <br /> ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection 3 <br /> i 7b.Alteroaie Facility(or Generator) Shiomenl Tracldn Number. <br /> U.S.EPA ID Number <br /> U <br /> tai FaciR y's Phone: <br /> m f 7c.Signature of Altercate Facility(r Generator) <br /> Q - Month Day Year <br /> Z <br /> cn <br /> -21,5Ki.R 575 <br /> ❑ - ^^tee a�� :�� `a 's Y `�'` ,,.,.� s `�` t-_y r ,� ; <br /> - ..a, :.t. -Lr•;c�=: zi-_ i `sec 4 ", � 'z a _`.vim- <br /> 18 Des;ynared Faahty Ov+n r or Operator.Certification of receipt of materials covered by the shipping document except as noted in Item 17a <br /> Pr, aTyped Name <br /> Sign lure <br /> Month Dai r Year <br />