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--,aVEOLIA <br />ENVIRONMENTAL SERVICES 1111111111111111111111111111 4 GENERATOR I. I SHIPPING <br />DOCUMENT <br />1. Generator ID Number <br />NOT REQUIRED <br />2. Page 1 of <br />1 <br />3. Emergency Response Phone ' <br />(877)818-0087 <br />4. Shipping Document Tredong Number <br />ZZ 00589708 <br />5. Generator's Name and Mailing Address DKiTO MCILDMAS Generator's Site Address (If different then mailing address) <br />CAL (ION CARBON' SAME <br />3200 EMT 8 MILE ROAD <br />STOCKTON, CA 95212 <br />Generator's Phone: 412 787-4793 I <br />6 Transporter 1 Company Name .. U.S. EPA ID Number <br />DILLABD ENVIRONMENTAL SERVICES 1 CAD 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 Facility Narne and Site AddremuST BAY MUD (EBM) U.S. EPA ID Number <br />2020 WAKE AVENUE <br />OAKLAND, CA 94607-51,00 <br />IN E <br />Facients Phone: 510 986-7835 0 7 R Q 3 5 5 <br /> <br />he 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10 Containers It. Total 12. Unit 13. Codes <br />Hki and PackMg Group (4 any)) No. Type Quantity WtNol. <br />1. NON-HAZARDOUS LIQUID, (WATER) NONE <br />1 TT 5 0 0 0 G <br />2 <br />3 <br />4 <br />Special Handling Instructions and Additional Infomation ER Service Contracted by VESTS -I- Contract retained by generator <br />confers agency anthoriri on initial transporter to add or substitute additional transporters on generator's behalf -I- 1) VV: <br />384630 kE134TEEN3000-038 <br />GENERATOR &OFFEROR 8 CERTIFICATION: I hereby declare that the contents of this consignment are My and accurately described above by the proper shipping name, and are dueled, packaged, <br />marked and labeled/placarded, and are that respects in proper concfraon for transport aa:onling to applicable International and national governmental reputed:ma. <br />rs Pnnted/Typed Name Month tray Year Gerieratoeselero Signature <br />i'lle(le. i'N 11A c e_te, - I <br />..dit.....fri <br />-.1 <br />F- <br />z <br />16 International hipments <br />III U.S. . Export from U.S. Port of entry/ 0- °UC4 Import to <br />Transporter signature (for exports only): Date leaving .S.: TRANSPORTER( 17. Transporter Acknowledgment of Receipt of Shipment <br />Transporter 1 Printed,Typed Name Month Day Year <br />ef,9'1 .47210 711 i'ir,l''.‹r—• <br />.sorres. r2---12- <br />Transporter 2 Rinted/Typed Name Lignature Day Yew <br />I I I I 4----- DESIGNATED FACIUTY 18. Discrepancy <br />18a, DISCrePanCY inckation Space . Quantity IIII Type 1111 Residue . Partial Rejection E Fun RejectIOn , <br />Shipping Document Tracldno Number <br />Alternate Facillty (or Generator) U.S. EPA ID Number <br />Faalitys Phone: I <br />8ignatare of Mternate Fadfrty (or Generator) Month Day Year <br />I I I <br />19. Report Management Method Codes (i.e., codes for treatment disposal, and recyciing systems) <br />1 2. 3 4. <br />20. Designated Fealty Owner or Operator. Certification of receipt of shMment except as noted In Item 18a <br />Printed/Typed Name SIgnabse Month Day Year <br />I I I I <br />DESIGNATED FACILITYTO GENERATOR