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SHIPPING 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Shipment Tracking Number <br /> DOCUMENT CAL000427616 1 8775772669 411292970BOL <br /> 5.Generator's Name and Mailing Address Generator's Site Address(it different than mailing address) <br /> Bath & Body Works 1510 Bath & Body Works#1510 <br /> 2094729339 4950 PACIFIC AVE, WEBERSTOWN MALL./ SPACE 4950 PACIFIC AVE <br /> Generator's Phone: 209472 STOCKTON, CA 95207 STOCKTON, CA 95207 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Stericycle Specialty Waste Solutions Inc MNS000110924 <br /> 7.Transporter 2 Company Name p� Q U.S.EP8 ID Number �— T <br /> 8.Designated Facility Name and Site Address s U.S.EPA ID Number <br /> 2095 Newlands Dr. East <br /> Fernley, NV 89408 <br /> Facili 's Phone: 7755752760 NVD980895338 <br /> 9a. 10.Containers 11.Total 12.Unit <br /> HM 9b•U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number,and Packing Group(it any)) <br /> No. Type Quantity wt.Nol. <br /> 1-Consumer Electronics for Recycling 1 CF 00002 P <br /> 0 <br /> a <br /> w <br /> z 2. <br /> t7 <br /> 3. <br /> 4. <br /> 13.Special Handling Instructions and Additional Information 1. 111131 (Consumer Elect r o n i c s f f]r Recycle) <br /> 14.GENERATOR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and aaumtety descr' by the p r shi ing name,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 re aligns <br /> Ge atoes/Offeror's Printed/Typed Name Sign tura p o n e h a l f of L i®i t o Month Day Year <br /> ya�c__— 07 19 01 <br /> 15.International Ship nts <br /> H ❑Import to U.S. ❑Export from U.S. Port i entry/exit: <br /> K Transporter Si nature for exports only): e lea U.S.: <br /> t¢ 16.Transporter Acmowledgment of Receipt of Materials <br /> Transporter 1 Printed/ryped Name ign ure Month Day Year <br /> AnthonyMack <br /> Transporter 2 Pdptedliyped Name Month <br /> �GGC.0 gnature Day1 1s Year <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space <br /> ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Shi mentTrack' Number: <br /> 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> a Facility's Phone: <br /> w 17c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> { <br /> W <br /> AMR, <br /> �. <br /> ,q ', <br /> 18.Designated Facility Owner or Operator:Certification of receipt of materials covered by the shipping document except as noted in Item 17a <br /> Printed✓fiypedName �� Signature Month Day Ye <br /> 169-BSC-0(Rev 5-11) DESIGNAT CILITYT GENEFi�ATOR <br />