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I IV <br /> VV <br /> VI IV <br /> BILL OF LADING/MANIFEST 1 . Shippers US EPA ID No. (If Applicable) Document No. 2. page 1 <br /> itu °f <br /> 3. Shipper's Name and Mailing AddressI% eel <br /> - - <br /> j <br /> )Mi{} 4. Shippers Phone <br /> �t Irk <br /> 5. Transporter 1 Company Name 6. US EPA ID Number A. Transporters Phone <br /> _. <br /> t( {t 7 Transporter Company Name 8. US EPA ID Number B. Transporters Phone <br /> It <br /> 9 Designated Facility Name and Site Address 10. US EPA ID Number C. Facility's Phone V IV <br /> ,I <br /> t ' i <br /> i �{ <br /> eel <br /> f{ Ve <br /> 11 Shipping Namaland Description 12. Containers 13. 14 <br /> tt Total Unit <br />} HM No. Type Quantity WWol <br /> a. <br /> a <br /> 1 Ilk <br /> bIVI1v I <br /> S1, . .. . . _ <br /> Hle <br /> i I o i <br /> P <br /> E <br /> R .+ ,.. . <br /> dVkIkIlIVIV <br /> le <br /> 15 Special Handling Instruction and Additional Information VV <br /> r . , I . ri <br /> „ <br /> I � r .- - r <br /> s. tt 1 <br /> le <br /> r _ el <br /> _ . . . <br /> 1lee <br /> 'This Is m deny manna abovenamad ratanes are property datafaa described, packaged, m labeled and arae proper <br /> { 16a. US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: condition for sane ormr cordln m <br /> rintedrTyped Name o a on me ns Orme oe arcmon of trans orcauon M th Day Year <br /> 11 16iNON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on Inis farm are not subject to federal regulators for Transportation or Disposal. <br /> I f;Printedriyieed Name Monts Day Year <br /> T : 17 Transporter 1 Acknowledgement of Receipt of Materials ' <br /> R 5 nature Month Day Year <br /> 1 A Prntedrfyped Name g <br /> s r <br /> Is r <br /> lee <br /> 0 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> Ve <br /> eel <br /> R Pnnted/Typed Name Signature Month Day Vear <br /> E <br /> R <br /> 19, Discrepancy Indication Spacelee' <br /> F '. <br /> A <br /> C <br /> t lee <br /> It L : :20 Facility Owner or Operator.. Certification of receipt of materials covered by this form except as noted in Item 19. <br /> 1 <br /> d T <br /> ' y PrntedFryped Name Signature Month Day v <br /> Ij <br /> t �31� �t1 i ! tn MV} l(' t} 14S \l }l St i t ; 'i £ 1� llee <br /> 1 �1}{J} {ltlk t )t <br /> %i: <br /> g <br /> GENERATOR'S COPY FORM NO. 01 -90291 (03/2015) <br />