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c+eainh+ trill of I arlinn - Shnrt Fnrm - Orininal - Not Negotiable Shinoer's Number: S-197136 Date: 12/10/2015
<br />Shipper (from)
<br />Consignee (to)
<br />*CERA*
<br />LAWRENCE LIVERMORE NATL LAB FOR NNSA
<br />Clean Harbors Environmental Services, Inc.
<br />CORRAL, HOLLOW ROAD
<br />1021 Berryessa Road
<br />TRACY, CA 95375
<br />San Jose, CA 95133
<br />Technical Contact
<br />Contact Name:
<br />Job/Work Order: Project 32150 Task OPS.RHWM.SD
<br />Route:
<br />Reference #:
<br />No.
<br />Weight
<br />Shipping
<br />Type of Package
<br />HM
<br />Description of Articles, Special Marks, and Exceptions
<br />NMFC Item No.
<br />Class Rate
<br />(Subject to
<br />Units
<br />(Subject to Correction)
<br />Correction)
<br />1
<br />PALLET, WOOD
<br />Non-regulated waste, solid (fluorescent straight tubes) (DOP0165-1)
<br />a
<br />250 lb
<br />2
<br />DRUM, 85 -GAL
<br />Non-regulated waste, solid (fluorescent straight tubes) (DOP0165-1)
<br />_
<br />228 lb
<br />1
<br />DRUM, FIBER
<br />Non-regulated waste, solid (fluorescent U-shaped tubes) (DOP0166-1)
<br />y> Zig
<br />35 lb
<br />q <
<br />1
<br />DRUM, FIBER
<br />Nan -regulated waste, solid (broken fluorescent tubes) (DOP0173-1)
<br />z A
<br />27 lb
<br />Fri Z
<br />ITI
<br />N
<br />Z
<br />O_
<br />'.
<br />M
<br />925) 422-7492
<br />IN THE EVENT OF AN EMERGENCY, TELEPHONE ( - 24 HRS
<br />loth.event.1d-9..,bvoflhemat.rialde tc dm
<br />t�, s�u.f u.a�,yv,h�b�r,m.p.b..f th.o.d.*.1n.
<br />590 lb
<br />5
<br />< < Total Pieces
<br />Contact or Registrant Name, or Contract Number LLNL Emergency Dispatch
<br />,,.r•9,...1. —ify th..hipp. /'... 9,,.....1ro.1...
<br />245 kg
<br />FREIGHT CHARGES
<br />If this shipment is to be delivered to the
<br />This shipment is on behalf of the U.S. Department of Energy and the actual total
<br />,Remarks.
<br />ARE:
<br />consignee without recourse on the
<br />transportation charges paid to the carrier(s) by the consignor or consignee are
<br />SJUN15-04 , shipping document S - 197136;
<br />consignor, the consignor shall sign the
<br />assignable to. and shall be reimbursed by, the U.S. Government and is subject to
<br />Reference release number LSJ0340 on invoice;
<br />Prepaid
<br />following statement The carrier shall not
<br />the terms and conditions set forth in the standard form of the U.S. Government
<br />See attached packing list for container numbers.
<br />❑ Collect
<br />make delivery of this shipment without
<br />Bill of Lading and to any available special rates or charges
<br />❑ 3- Party
<br />payment of freight and all other lawful
<br />(41 CFR 109-40.50 and 41 CFR 109-40.3)
<br />charges.
<br />❑X Yes ❑ No
<br />(see Remarks)
<br />U.S. NNSA
<br />SECTION 13712/10721 RATES APPLY -TENDER NO.
<br />Received, subject to individually determined rates or contracts that have been agreed upon in writing between the carrier and shipper, if applicable, otherwise to the rates, classifications and rules that have been established by the carrier and
<br />are available to the shipper, on request The property described above, in apparent good order, except as noted (contents and conditions of contents of packages unknown) marked, consigned and destined as shown herein, which said
<br />carrier (the word carrier being understood throughout this contract as meaning any Person or corporation in possession of the property under the contract) agrees to carry to its usual place of delivery at said destination, if on its route,
<br />otherwise to deliver to another carrier on the route to said destination. It is mutually agreed, unless otherwise specifically stated in individually determined
<br />rates and contracts that have been agreed upon in writing between the carrier and
<br />shipper, as to each carrier of all or any of said property over all or any portion of said route to destination, and as to each party at anytime interested in all
<br />or any of said property, that every service to be performed hereunder shall be subject
<br />to all the terms and conditions of the Uniform Domestic Straight Bill of Lading set forth (1) in Uniform Freight Classification in effect on the date hereof, if
<br />this is a rail or rail -water shipment, or (2) in the applicable motor carrier classification
<br />or tariff if this is a motor carrier shipment Shipper hereby certifies they are familiar with all terms and conditions of the said bill of lading, set forth in the
<br />classification or tariff which govems the transportation of this shipment, and the said
<br />terms and conditions are hereby agreed to by the shipper and accepted for him/herself and their assigns.
<br />This is to certify that the above named materials are properly classified, described, packaged,
<br />Trailer Loaded by: El Shipper ❑ Dover
<br />Placards Required: Label(s) applied
<br />acarq PP
<br />marked, labeled, and are in proper condition for transportation according to the applicable
<br />regulations of the Department of Transportation (Applicable for Hazardous Materials Only)
<br />Freight Counted by.
<br />❑ Shipper
<br />❑ Driver, Loose pieces
<br />Shipper, acting under contract DE-AC52-07NA27344 with the
<br />U.S. Department of Energy:
<br />❑ Driver, pallet said to contain
<br />❑ Driver, pallets containing
<br />ON BEHALF OF NNSA
<br />Carrier CLHA / Clean Harbors Environmental Service, LLC
<br />Vehicle/Car No:
<br />Per Date /� t
<br />Kimberly A. Fpgman
<br />Per / Date 12/10/2015
<br />Seal:
<br />TRANSPORTATION DEPARTM Nf-ERMANENT POST OFFICE ADDRESS OF SHIPPER Ynbt 1 U],1
<br />
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