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kwIIw­III <br /> Ilk <br /> , ,.. , . ..�:.: t , m.; } ttSttEy� €771;4 `';, , �,}l �� 11U'r4iS �tl�?a1 '� 1 t " — <br /> 1 . Shipp Ys US EPA ID No If Applicable) <br /> Pa e 17�� <br /> t ti <br /> BILL OF LADING/MANIFESTle Ir <br /> 50 <br /> 9iI <br /> 9. Shipper's Name and Malting Address __ a 33t _ i 1' 'r ' "; 'i °� �! 7/ <br /> - z t rIFra if nw`6v _ t <br /> b � E Ll c hr c :cl dt <br /> I'D I��.,i,l <br /> 4. Shipper's Phone ( LHS 3 <br /> 5 Transporter 1 Company Name 6. US EPA ID Number A. Transportel' <br /> Y f F 4 _ !' 7" ,.. v rp 4.k o '= ✓ . 71, <br /> 7 Transporter 2 Co pang Name a. US EPA IDNumber B. Transporter's Phone <br /> immro.�,_ .t'f .. ,. .-_ � , . � c3*>", ,° Tt .'D.+i. t._S ��d' y 3 -° L 46 .� _ , VoI - _+,. .. _,_: - '�k'� f - — , J _ _. _1-tiiire <br /> I 9 Designated Facility Name and Site Address f ° S low US EPA ID Number <br /> p_. C. Facility's Phone <br /> ( I I L `. 1' a s r _a s � OF <br /> ;fir M; . A SsR ET <br /> 'lle . ? ?_'B�l � S 9f-.T; , ;i Ila0A 9074-'r . . ,£?3�7[ r . _ . S _. _, � :; t%% - <br /> I11 . Shipping Name and Description 72. Containers o� 13.E 14. s <br /> ., Total Unit <br /> HM No. Type Quantity Wt/Vol ' <br /> rI <br /> I a L1E 0 th- C1 Lr �t r ,0 1 an a• 1 :;r FI <br /> 15, L fnA a1 ; 01 <br /> 7 etas , ta6' I � yERSPL . l", _, €�E OSTILG , <br /> rte . <br /> l♦ ? b. <br /> 46 <br /> YI H c 'A <br /> P <br /> kc P <br /> E <br /> R <br /> It <br /> kk <br /> 15. Special Handling Instruction and Additional Information <br /> I" G kr I fcr �fv✓ <br /> 24H E_ViEPG!b1. 7 0, c x-I Si- ¢ o eiDifC� -iITai a ;.s F'EmI-.— _ ,a ADD _. . , k <br /> D r r r Rr ,. A =i 193GO / 1 . ha e a3S )_ <br /> Rw, NONE ED C Lia <br /> Ilk <br /> Ai <br /> ✓p ( � <br /> 16a. US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: 'This ls to cart"atme eeovo-nameamarerissars propervoasslnea aescanaa, eachwasm nearked and III and are in proper <br /> Consider forlinvejoinvion according toNhe stars Pr nt d N me ♦ u Mo h !Y1 <br /> Year <br /> M �� { peonal rt <br /> EM <br /> 16b NON-REGULATEDSHIPPER'S TIFICATION: ( certify the materials described above on tris form are not subject to federal regulations for Transportation or Disposal. <br /> -Pnnted/Typed Name Monk <br /> p R 17. Transporter 1 Acknowledgement of Receipt of Materials n a <br /> N . nnted/Typed a e _ � Signature Month Day Year <br /> I le9 <br /> P <br /> 0 78 Transporter 2Ack ledgement of Receipt of Materials <br /> t T Prntedrryped a SignatureMon Day Year <br /> R Sc� r <br /> Ij r 19. Discrepancy Indication Space <br /> F <br /> tt C . , 1� <br /> "Ilk <br /> , <br /> i� L , 20. Facility Owner or Operator. Certification of receipt of materials covered by this form except as noted in Item 19. - <br /> Pnntedlryped Name RR Signature Month Day year <br /> to s <br /> �� - . : >,' ,- s ♦ i f tit C { r'S '•it t � t .__-y— T., <br /> ORIGINAL-RETURN TO GENERATOR FORM NO. 01 -90291 (03/2015) <br />