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ict) VEOLIA <br />ENVIRONMENTAL SERVICES <br />11111111111111111111111111111 GENERATOR SHIPPING <br />DOCUMENT ZZ <br />1. Generator ID Number <br />NOT REQUI RED <br />2 Page 1 of <br />1 <br />3. Emergency Response Phone <br />(8773 818-0087 <br />4. Shipping Document Tracking Number <br />0 0 5 9 4 9 03 <br />S Generator's Name and Maill g Address Generator's Site Address (if different than mailing address) <br />DAVID MCADAMS <br />CALOON CARBON SAME <br />3200 EAST 8 MILE ROAD <br />STOCICTON, CA 95212 <br />Generatoes Phone: 417 7R7-474111 I <br />Transporter 1 Company Name U.S. EPA ID Number <br />DILLARD ENVIRONMENTAL SERVICES ICAD9 8252 :F 4 3 3 <br />Transporter 2 Company Name U.S. EPA ID Number <br />I <br />8 Designated Facility Name and Site Address U.S. EPA ID Number <br />EAST BAY MUD (EBM") <br />2U 2t WAKE AVENUE <br />OAKLAND, CA 94607-5100 <br />FaciliWs Phone 510 Sgy6_7835 INOT REQ 3 5 5 <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard (lips, ID Number. 10. Containers 11. Total 12. Unit 13. Codes <br />_im and Packing Group (if any)) No Type • Quantity Wt.Nol. <br />NON-HAZARDOUS LIQUID, (WATER,) NONE <br />• TI 3 0 0 0 0 <br />2 <br />3 <br />i 1' <br />14 Special Handling instisctions and Additional Information ER. Service Contracted by VESTS - - Contract retained by generates confers <br />a,gency authority on initial tran-corter to ackl ar sabatitnte additional tnnspoiters on generator's bebalf + 1) W3346.3.0 A.EB- <br />VEEN3000 -038 <br />15 GENERATOR &OFFEROR S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by Use proper shipping name, and are classified, packaged. <br />marked and labeled/placarded, and are in all respects m proper condition for transport according to applcable international and nabonel governmental regulations. <br />'rear GenestOWOfferor's Pnntedrryped Name Signature_ i Month. Day <br />bie / e ,-, 1:_ce_ n s'a 0 I . •---.4--- s fl-ivri ;)-(241/J47-1_ I Y I ter1.0 <br />..... <br />r— = <br />16 International Shipments II E Export from U.S. 7-..,rt nier•Iy...3 Import to U.S. <br />Transporter signakee (tor exports only): Dote leaithd I.J S . TRANSPORTERI IT. Transporter Acknoveedgment of Receipt of Shipment <br />• transoorter 1 Pnnter9Typed:a2 Signa /: Month Uay Year <br />' ‘V <br />LtIr I /r I a° <br />'51ler14(Printay Plped Na/p,V ./natur8. nth Day Year <br />I I I I DESIGNATED FACILITY 18 Dscrepanry <br />As Discrepancy Inditstion Space 11.1 Quantity IIII Type M Residue E Partial Rejection 111 Full Rejection <br />Shipping Document Tracking Number <br />18b Alternate Facility (or Generator) U.S. EPA ID Number <br />Facilitys Phone: I <br />18c. Signature of Alternate Facility (or Generator) Month Day Year <br />I I I <br />'9 Report Management Method Codes (I.e.. codes for treatment. disposal, and recycling systems) <br />2. 3 4. <br />20 Designated Facility Owner or Operator. Certificabon of receipt of shipment except as noted in Item 180 <br />Pnnted1Typed Name Signature Month Day Year <br />I 1 I I <br />___.__..___ _._..._.-- —.--.........