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IDNEOLIA <br /> <br />1111111111111111111111111111111 <br />ENVIRONMENTAL SERVICES GENERATOR SHIPPING <br />DOCUMENT <br />I. Generator ID Number <br />NOT REQUIRED <br />2. Page 1 of <br />1 <br />I 3. Emergency Response Phone <br />(877)818-0087 <br />4. Shipptng Document Tracking Number <br />ZZ 0 0 5 8 9 7 0 7 <br />8 Generator's Name and Mailing Address 1.3.k.4 113 M\,A13n1i& enenatoa Site Address (If different than mailing add,ess <br />CALCrOW CARBON' SAME <br />3200 EAST 8 141LE ROAD <br />STOCKTON, CA 95212 <br />Generator's Phone: 412 787-4793 I <br />8 Transporter 1 Company Name - U.S. EPA 10 Number <br />DILLARD EN.VIRONIIENTP1 SEBMICES 1 C A 0 9 8 2 f: 2 3 4 3 3 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />I <br />9. Designated Facility Name and Site AddrenEAST BAY MUD (EBM) U.S. EPA ID Number <br />2020 WAKE AVENUE <br />OAKLAND, CA 94507-51110 <br />pwirdy, phow, 510 986-7835 I iiil r_i 7 7-,. c. 3 5 5 <br />sa. Ob. U.S. DOT Desaiption (nduring Proper Shipping Name. Hazard Class 10 Number, ' 3 Containers 11 lytat 12 Una 13 Codes <br />NM and PiKkIng &don Of &IA Nc Type (.:PMP',,P. tigt.Nol <br />ili NO14•HAZARDOUS LIQUID, (WATER) NONE I <br />I T T 5 1.: Ci r: G <br />2 <br />3 <br />4 <br />14 Sperpal Handling Instructions and Addrbonal Information ER. Semite Contracted by VESTS -I- —ontract retained by generator <br />confers agency authority on initial transporter to add or substitute additional transporters on generator's belief -1- 1)W: <br />3846.30 ArEB-VEEN30130-038 <br />IS GENERATOR &OFFEROR S CERTIFICATION: I hereby declare that Me contents of this consignment are Adly and accurately described above by the proper shipping n <br />marked and labeledLibilacarded. and seen all respects in proper condlition for transport accordtng to appticable international and national governmental regulations. <br />e, and are classified packaged <br />GeneratodsrOfferods Prhitedayped Name / Signature Mann Linty Year <br />1:1)1-1A,Ce. Tpc.t.-..cm,,,r-fie.. lzP I -E;;74-?-e- "e;f4A1,4 /, .4( <br />z <br />International Shipments 7- 2-g• ye, E Import II Port ol entry/exit to U.S. Export boor U.S. _ i, <br />Transporter signature (for exports only). Date leaving U.S TRANSPORTER' Transporter AcknoWedgment of Receiptof.ShircosoI Month llay Year <br />Transporter 1 P i 'T Name <br />I <br />.7/' <br />I <br />Svnair, <br />diji2nsporter nntediTypilNarne <br />month Day rear I DESIGNATED FACILITY -1. 1' Otscrepancy <br />1&e. Discrepancy Incticabon Space 0 . II Type In Residue II. Parhat Refection r-L Full Rejection . <br />Shipping Document Tracking Number. <br />18tY Alternate Facility (or Generator) U S. EPA ID Number <br />FRCiiity'S Phone I <br />18c S nature of Alternate Factlity (or Generator) Month Day Year <br />I I I <br />'9 Repon Management Method Codes (i e , codes for treatmenl. disposal, and recycling sysgerns) <br />2 3 4. <br />27 Designated Facttity Owner or Operator Certificahon of receipt of shipment except as noted in Item 18a <br />PnntediTyped Carte Signature Month Day Year <br />I I I I <br />Vj.