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GALgOLIA <br />ENVIRONMENTAL SERVICES UMW 4 GENERATOR SHIPPING <br />DOCUMENT <br />1 Generator ID Number <br />NOT R_EQU1 RED <br />2 Page 1 of <br />1 <br />3 Emergency Response Phone <br />(77)819-0087 <br />4. Snaring DOCument Tracking Number <br />ZZ 0 0 5 8 9 7 0 6 -C7enerators 5. Geneoatoes Name and Maging Address DAVID MCADAMS Sae Address (if different than maittng address) <br />CALGON CARTON SAME <br />3100 EMT 0 MILE ROAD <br />STOCKTON. CA 95212 <br />Generatoes Phone) 412 7874793 I <br />6 Transporter I Company Name U.S. EPA ID Number <br />DILLARD ENVIRONMENTAL SEM/ICES 1C A D 9 8 2 5 2 3 4 3 3 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />I <br />8, Designated Faday Name and Site AddresSAST BAY MUD (EBM) U.S EPA ID Number <br />2020 WAKE AVENUE <br />OAKLAND, CA 94607-5100 <br />Nay, phone: 510 986-7835 11107 REQ 3 5 5 <br />go. 9b. U.S. DOT Desaipeon (including Proper Shipping Name, Hazard Class, ID Number, 13 Contamers 11 Total 12. Unit 13. Codes <br />HM and Packing Group (if arlY)l lio Typo Quantity WI Not <br />NON-HAZARDOUS LIOUID, (WATER) NONE <br />1 T 7 5 0 0 0 0 — <br /> <br />' 4 Special FlandlIng Instrucuons and Additional Information ER Service Contracted by <br />confers agency authority on initial transporter to add or substitute additiona1 <br />384630 A: EB-VEEN3000-038 <br />JESTS -I! Contract retained by generator <br />transporters on generator's betiarE -!- 13 W: <br />15 GENERATOR S/OFFEROR $ CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping rains, and are dasslOad, packaged. <br />marked and labeled/placarded. and are call respects In proper condition for transport according to applicable International and national governmental regulations <br />GenerarcesOfferoes PnntedTyped Name Signature_ i „? MonthDay Fear <br />:. ---04-e-ke----ki ---e-11-1 ' 5'e 0 1 -7(-42Z -a-1 1 4 F I .7124 P_ <br />—J <br />I— Z <br />16 lntomaorralhmarrto c)1 A.? .9.'" E ,mport to U.S. . Export from 11 S. Port of entrylexit <br />Transporter nnature rfOf exports only) Date lean ng U S. TRANSPORTER( 17 Transporter Acknowledgment of Rectal"( of Shipment <br />en 1 Pnnter Name Cigna Month Day Year Ad <br />0: 105)11 c/ l'-71 067 <br /> <br />Tkrter Ynteofir(oed Name .a ore van Day Year . <br />1 I 1 -4- DESIGNATED FACILITY 18 Orscrepancy <br />18a Discrepancy Indication Space 11 Quantity . Type IIII Residue D Portal Relecbon MI Full Rejector. <br />Shipping Document Tracking Nuniber <br />18b. Alternate Facility (or Generator) U.S EPA ID Number <br />Facritys Phone) I <br />lac Signature of Alternate Fealty (or Generator) Month Day Year <br />I I I <br />it Report Management Matted Codes (i ra . nodes for treatment. disposai and recycling systems) <br />2 3 4 <br />20. Designated Facility Owner Of Operator Certificabon of receipt of shipment except mooted in item I aa <br />Printed/Typed Name Signature !font) Day Year <br />I I I I <br />DESIGNATED FACILITY TO GENERATOR