Laserfiche WebLink
3ILt+r] 1 i <br /> SHIPPING 1.Generator iD Number 2.Page 1 of 3.Emergency Response Phone 4.Shipment Tracking Number <br /> 266 <br /> DOCUMENT CALt3f� 1487614 1 8775779 4189_11GOBOL <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Bath & Body Works 6-5 Bath & Body Works#E5 <br /> 2099524 96 5308 PACIFIC AVE, SHERWOOD MALL/ SPACE S 51308 PACIFIC AVE <br /> Generator's Phone:209952 STOCKTON, CA 9507 STOCKTON CA 95207 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Steric cle Specialty Waste Solutions Inc MNSOOV1110S84 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address `15 t Century Environmental Of CA U.S.EPA to Number T{' <br /> 11855 White Pock Road <br /> Rancho Cordova, CA 95742 ,iso <br /> Facili 's Phone: CAR000 10617 <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(if an <br /> No. Type Quantity Wt.Nol. <br /> 0 'Consumer Electronics for Recycling 1 CF 00008 <br /> a 3 <br /> ZLu 2 r: <br /> 3. »' <br /> 4. <br /> 13.Special Handling Instructions and Additional Information <br /> 1. 1111-41 (Con5umer Electronics for Recycle) <br /> 14.GENERATOR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping 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 regulations. <br /> `J <br /> Generator's/Offeror's PrintedlTyped Name Signatu r'R P o n b e h a l f o f L i m i t e Month Day Year <br /> 02 101 4LA19 <br /> .j 15.International Shipments _ <br /> ❑Import to U.S. ❑Export from U.S. Port of entry/exit: E'af k <br /> Transporter Signature(for exports only): Date leaving U.S.: <br /> ¢ 16.Transporter Acknowledgment of Receipt of Materials r:> <br /> w <br /> Transporter 1 Printed/Typed Name Sign Month Day Year <br /> 1 Jeff Hamilton {4 <br /> 08 t%.i : it 19 <br /> Z Transporter 2 Printed/typed Name Sign Month vDay Year <br /> Q <br /> F <br /> 17.Discrepancy F3 <br /> 17a.Discrepancy Indication Space <br /> ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> 4 <br /> Shipment TrackingNumber. ) <br /> F 17b_Alternate Facility(or Generator) U.S.EPA IC Number <br /> J <br /> U <br /> tai Facility's Phone: <br /> LOU 17c.Signature of Alternate Facility(or Generator) Month Day Year ='Ya <br /> a <br /> Z w=i <br /> 2 VA <br /> µ w <br /> o <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/Typed NameSignature Month Day ear <br /> 169-BLC-0 (Rev.5-11) <br />