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BILL OF LADING/MANIFEST Shippers US EPA ID No. Applicable) Document No. 2 P ga <br /> 1 - -_ � . D <br /> 3. Shipper's Name and Mailing Address <br /> z — <br /> if 4. Shippees Phone ( <br /> 5. Transporter 1 Company Name 6. US EPA ID Number A. Transporter's Phone <br /> 7 T dnsporter 2 Compaoy 1`Iarpe Sv _ 8. U$ F�PA1P_INurpbgr B Tra sporter's Phone <br /> 9 Designated Facility Name and Site Address 10. US EPA ID Number C. Facility's Phone <br /> t 11 Shipping Name and Description 12. Containers 13. ' 14. <br /> TotalUnt <br /> HM No. Type Quantity Wallol I <br /> lk <br />,t a in <br /> b ;-{ <br /> dd <br /> S <br /> H <br /> I c <br /> P _ <br /> P <br /> R d. <br /> 15. Special Handling Instruction and Additional Information <br /> r„ <br /> W11Z = r <br /> 7= <br /> tr <br /> e' <br /> e + e _ <br /> % �. a _ •; t= <br /> 16a. US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: 'This luno Cairlthat me above-named ahead reereou�iolnss.rod dosmnmeeosi'9Oemarked anmzbeled and are proper <br /> r Aaron 'ea oo a n Trane onaron <br /> Printed/Typed Name ,, '7 Month Day Year <br /> .> C//4 ��- � y MEW t I a YI ��A <br /> 16b. NON-REGULATED SHIPPER'S CERTIFICATION: I manly the materials descrbed above on this form are not eat to federal regulations for Transportation or Disposal. <br /> o Printed/Typed Name Month Day Year <br /> ' T : 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> A �Printed��YPe�d`Nar� Sig e Month Day <br /> —`i ` o p <br /> R Year <br /> $ N <br /> 5 <br /> P <br /> 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> TP d/T of Name �r'� Signature / M nrh Day Year <br /> /D <br /> i - i r a <br /> 19 Discrepancy Indication Space <br /> F <br /> F <br /> A <br /> C <br /> - L 20. Facility Owner or Operator. Certification of receipt of materials covered by this form except as noted in Item 19. <br /> 1 <br /> T Month Day Year <br /> Y Prntedl7ype Name Signature <br /> y �y <br /> a <br /> nRIr. INAI RFTl1RN TO r; E _ <br /> N BATOR <br /> FORM NO. 01-90291 (0312015) <br />