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3. Emergency Response Phone <br />(877) 818-0087 • <br />2 Page 1 ot <br />1 <br />DaportfromUS Pon of entry/exit <br />Date leaving U.S.. <br />VEOLIA <br />„.............-PENVIRONMENTAL. SERVICES <br />SHIPPING <br /> I. Generator ID Number <br />DOCUMENT <br /> NOT REQUIRED 4 Stripping Document Tracking Number <br />ZZ 00589709 5. Genenitor's Name and Mailing Address DAV ID rew ;Ian <br />CALOON CARBON t,...er.ierator's Site Address (ti different than mailing address) <br />:DAME 3200 EAST TELE ROAD <br />STOCKTON, CA 95212 <br />Generator's Phone: 412 7874793 <br />6. Transporter 1 Company Name <br />T. .LkPn • RRI1V1.7-5 U <br />d Ei[AlbNur6bers 2 5 2 3. 4 3 3 <br />1111111111111111011111111111 <br />7. Transporter 2 Company Name <br />U.S. EPA ID Number <br />8. Desgnated Faddy Warne and Site AddreseEAST BAY MUD (EB hi) 2010 WAKE AVENUE <br />OAKLAND, CA 94607-5100 <br />Facility's Phone 510 986-7835 3 5 5 <br />9b. U.S. DOT Description (including Proper Slapping Nene, Hazard Class, ID Number, <br />and Packing Group (deny)) <br />U.S. EPA ID Number <br />I NOT REQ <br />9a <br />HM 10. Containers <br />13 Codes No. <br />12. Unit <br />WtNol. <br />1,1, Total <br />Quantity Type 1. NUN-I-LAGAIWOUS (.1/VATER) <br />5 0 0 0 TT 1 <br />2 <br />3. <br />14. Special Handling Instructions and Additional Information ER Service Contracted by 1/ESL'S -I- .-ontract retained by generator <br />confers agency authority on initial transporter to add or substitute additional transporters on generator's behalf 1) W. 384630 REB-VEEN3000-038 <br />15 GENERATOR SIOFFEROR S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, end are classified, packaged, <br />marked and labeled/placarded, and are in all respects In proper cofidition for transport according to appricable international and national governmental regulIcrrs. <br />4 <br />• <br />F- <br />18. Discrepancy <br />Month Day Year <br />1,97 r 1-1 I 9 <br />gbf 2—a <br />Year <br />2-42 <br />gnature Or Day Year <br />I I I <br />Gemetor's/Offeror's Pnnted/Typed Name <br />race. <br />16 International Shipments <br />Dimon to LIS. <br />Transporter signature (for exports only). <br />17. TransporterAcknowledgrnent of Receipt of SNpment <br />Transporter 1 Printed/Typed Name <br />Ze.1.,4:7-z-,0 4 <br />Transporter 2 Printed/Typed Name <br />18a. Discrepancy Indication Space El L_.1 Quantity El Type LI Residue EPartial Rejection Put Rejection <br />186 Alternate FaaTrly (or Generator) <br />Fealty's Phone: <br />1& Signature of Altemate Filially (or Generator) <br /> <br />Month Day Year <br />Report Management Method Codes (i.e., codes for treatment disposal, and recycling systems) <br />12. <br /> <br />4. <br /> <br />Designated Facility Owner or Operator Cedificabon of receipt of shipment except as noted in !tern 18a <br />Pnnted/Typed Name <br /> <br />Signature Month Day Year <br /> <br />DESIGNATED FACILITY TO GENERATOR <br />Shigping Document Tracking Number. <br />U.S. EPA ID Number