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SHIPPING 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Shipmentlracking Number <br /> DOCUMENT CAL000427614 1 877577569 411406820BOL <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> Bath E Body Works 65 Bath & Body Warks#G5 <br /> 2099524396 5308 PACIFIC AVE, SHERWOOD MALL/ SPACE 6 5308 PACIFIC AVE <br /> Generators Phone: 208952 STOCKTON, CA 95207 STOCKTON, CA 95207 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Stericycle Specialty Waste Solutions Inc MN5000110924 <br /> 7.TransporteZ2pan ame <br /> �. U.S.EPA ID Number <br /> ® <br /> 8.Design Facility Name and Site ddress 4 en Ury , LLL U.S.EPA to Number <br /> 2:095 Newlandt Dr. East <br /> Fernley, NV 89408 <br /> Fact' sPhone: 7755752760 NVD980895338 <br /> 9a. 10.Containers <br /> HM 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number,and Packing Group(if any)) 11.Total 12.Unit <br /> No. Type Quantity wtNol. <br /> i" ansumer tLectronics for Recycling <br /> oa K <br /> w <br /> w <br /> Z <br /> 2. <br /> 3. <br /> 4. <br /> M1 fi'' <br /> - <br /> .. <br /> 13.Special Handling Instructions and Additional Information — L <br /> 1- 111131 (Co n s to■e r Er o n i c s for Recycle) <br /> 14.GENERATOR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately descr ve by the proper ship 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 reg tions <br /> Gen toeslOHerors Printed/ryped Name Sign urr6CL r n eh a I f of L i!i t e Month Day Year <br /> dam— 07 L 13 '018 <br /> ri 15.International Ship"' <br /> 76 Z Import to U.S. ❑F�port from U.S. Po of en 'A: <br /> TransporterSi nature for ex ortsonl : D leav' U.S.: <br /> LU <br /> 16.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 PdntedlTyped Name S' nature Month Day Year <br /> yAnthony Mack 114 07 13 018 <br /> Transpo 2 Printed/Typed Name Sign re + Month Day Year <br /> 17.Discre cy <br /> 17a.Discrepancy Indication Space <br /> ❑Quantity El Type ❑Residue ❑Partial Rejection El Full Rejection <br /> Shi mem Traddn Number: <br /> 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> L Facility's Phone: <br /> w 17c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> t <br /> t , <br /> 18.Designated Facility Owner ooDperator.Certification of receipt of materials covered by the shipping document except as noted in Item 17a <br /> PrintedlTyped Name 1 )fir L k-4 fD Signature J Month Day Year <br /> 169-BLC-0(Rev 5-11) DESIGNATED FACILITYTO GENERATOR <br />