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BILL OF.LADING/MANIFEST 9 ' Shipper's U5 EPA ID No. (If Applicable) Document No. 2. Page 1 <br /> D% - of <br /> 3 Shipper's Name and Mailing Address <br /> I <br /> 7#t >t 4. Shipper's Phone ( ) - <br /> ll 5. Transporter 1 Company Name 6. US EPA ID Number A. Transporter's Phone <br /> 7. Transporter 2 Company Name 8. US EPA ID Number B. Transporter's Phone <br /> 1 9 Designated Facility Name and Site Address _ 10. US EPA ID Number C. Facility's Phone I ">I <br /> 11 . Shipping Name and Description 12. Containers 13. 14 <br /> Total Unit <br /> HM No. Type Quantity Wt/Vol . "1 <br /> y I ' <br /> � a i <br /> � I <br /> b. <br /> Z S <br /> y H <br /> ' C. <br /> P <br /> _ . <br /> I� P <br /> E <br /> R d. <br /> 1 15. Special Handling Instruction and Additional Information <br /> ItK . . �_ _ _ - <br /> ` IL <br /> 16a. US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: "nilss to benry that me above-named materials am properly classified, descntped packaged, marked and labeled and are in proper <br /> condition <br /> forHan <br /> r s orcrd <br /> up� a�=on maoa Babe eam <br /> u ons or mn <br /> a Department or lr,, rc <br /> ,s oai on. <br /> Printed/TypedName month Day Year <br /> 1 16b. NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on the form are not subject to federal regulations for Transportation or Disposal. <br /> Prntedriyped Name month Day Year <br /> 17 Transporter 1 Acknowledgement of Receipt of Materials :. <br /> I A Pnntedrfyped Name Signature = month Day Year I.�I <br /> 1 N . L <br /> 6 r' <br /> P „ <br /> 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> R ' Printedrryped Name - Signature mpnm Day Year ' > <br /> 7 <br /> I E <br /> R <br /> 19. Discrepancy Indication Spade " <br /> A <br /> 1 G <br /> } I } <br /> L " 20 Facility Owner or Operator: Certification of receipt of materials covered by this form except as noted in Item 19. <br /> I <br /> I T <br /> Y Printed/Typed Name Signature month Day Year <br /> 11 <br /> WIV <br /> I � . r -44R; 'tt �bt' iirt ii} ltii it i � � iti tips1\i {1t �3v# vttj}t � Jlisltttt� t " I £ } U� # jttlltit tt <br /> 11i}£lrO?;f1t�/ 1i` rh {1 ar t4; t t t t 11h I � IUI:tit}1{ft3 h�41ttf {t l� rr lit t§ -.1itr <br /> t o- T} it� t tir k {a vet ', ~U 11 i if�y')t tt ; } ir r <br /> ti <br /> GENERATORS COPY FORM N0. 01 -90291 (03/2015) <br />