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SHIPPING 1.Generator ID Number 2.Page I of 3-Emergency Response Phone 4.ShipmentTracking Number <br /> DOCUMENT <br /> 5.Generators Name and Mailing Address (ienera-tors Site Address(ii different than mailing address) <br /> pm' <br /> A T FI—E <br /> r 3—= sf I—. �_I' <br /> Generators Phone: EPA 111-Number <br /> 6-Transporter 1 Company Name <br /> 7.Transporter 2 Company N <br /> U.S.EPA 10 Number <br /> za C, <br /> U.S.EPA ID Number <br /> B.Designated Facility Name and Site Address E'.M',1!N, LLIC <br /> Phone: -n 7 F, <br /> 10.Containers 11.Total r 12.Unit <br /> 9a. gb-U.S.DOT Description(including Proper Shipping Name,Hazard Class,10 Number,and Packing Group(it any)) — <br /> HM No. Type Quantity WtNal. <br /> ;='0:2r P <br /> 0 is <br /> LLJ <br /> Z 2. <br /> LTJ <br /> 3. <br /> 4. <br /> 13.Special Handling Instructions and Additional Information <br /> I i 3 <br /> 14.GENERATOR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described a <br /> by the proper shil�me,and are classified,packaged,marked and labeled/placarded,and <br /> are in all respects in proper condition for transport according to applicable international and national governmental regulatiopt. <br /> Ge rato(sK)fferoes PrintedfTypied Name Signature Month Day Year <br /> I <br /> zi 19.International Shipmen <br /> ElImporl to U.S. El Export from U.S. Pon qtlntrA: <br /> Trans rter Signature(for exports only): DateAeavi*U.S.: <br /> r <br /> rr 16.Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> Transporter 1 Printed/Typed Name Month Day Year <br /> ey0 <br /> z Trahij5bR6e2'1Prirftea,*- d Name Signature vonifi MY- —ye&— <br /> cc <br /> 17,Discrepancy <br /> 17a.Discrepancy Indication Space ❑Quantity ❑Type El Residue El Partial Rejection El Full Rejection <br /> ShiDment Tracking Number: <br /> 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> L<L Facility's Phone: <br /> 17c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Z <br /> 0. <br /> UJI <br /> 18.Designated Facility Caner or operator:Cerfification of recent of materials covered by the shipping document except as noted in hern 17a <br /> e./Typed Name Signature Month Day Year <br /> -7 <br /> 169-81_G=0{Rev5-11) <br /> DESIGNATED FACIUTYTO GENERATOR <br />