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EMPTY M CONTAINER PICK-UP SHIPPED FROM: CUSTOMER NUMBER: RETURN NO, CREDIT MEMO NO.: BRANCH: - DATE: SHIPTO: Univar USA Inc, UNIVAR DRIVER 2256 Junction Ave. TRUCKITRAILER#: San Jose, CA 95131-1216 CARRIER: QTY. HM DESCRIPTION AND PRODUCT NUMBER DEPOSIT t This is to certify that the above named materials are properly classified, described, packaged, marked and labeled, and are in proper condition for transportation, acc6rding to the applicable regulations of the-De€pariment of Transportation. . SHIPPER PER PN WRITTEN BY DATE RECEIVED BY DATE WHITE - UNIVAR DRIVER COPY YELLOW - CUSTOMER COPY PINK - OFFICE COPY r "` .,Jy PREPAID ❑ COLLECT ❑ The undersigned, on behalf of Univar USA Inc., acknowledges receipt of the property described below, in apparent good order, except as noted (contents and condition of contents of packages unknown), marked, consigned, and destined as indicated, and agrees to transport or arrange for transportation of such property to its usual place of delivery at such destination. SHOW EMCEPTIONSMEMARKS BELOW, LIST ANY CONTAINERS OR MATERIALS RECEIVED NOT SHOWN. CREDIT WILL BE ALLOWED FOR ITEMS SUBJECT TO COUNT AND CONDITION VLHIiIED AT OUR PLANT. SERIAL NO. SERIAL NO. SERIAL NO. SERIAL NO. SERIAL NO. SERIAL NO, EMPTY CONTAINER CERTIFICATION I hereby certify that these containers are "empty" as that term is definad in the Environmental Protection Agency regulations, 40 CFR 261.7', and that they have been properly prepared for transportation under the regulations of the U.S. Department of Transportation, 49 CFR 173.29." COMPANY NAME: (please print) DATE: SIGNATURE. Univar USA Inc. Poiy Drum 55 GAL. (PIN 248020) Act II or Contico Poly Drum 55 GAL. (PN 248020) Act II or Contico NOD EIPOSIT Poly Drum 15 GAL. (PIN 248100) Stainless Steel Drum 55 GAL. (PIN 248270) $800.00 Stainless Steel Drum 15 GAL. (PIN 248210) $400.00 Steel Drum 55 GAL. (PIN 333380) $25.00 Steel Drum 55 GAL. (PIN 333360) NOD POSIT Poiy Drum 55 GAL. (PIN 610679) Ferric Chloride $40.00 Poly Drum 55 GAL. (PIN 649068) Bleach -Hasa Replacement Bungs (PIN 306230) t This is to certify that the above named materials are properly classified, described, packaged, marked and labeled, and are in proper condition for transportation, acc6rding to the applicable regulations of the-De€pariment of Transportation. . SHIPPER PER PN WRITTEN BY DATE RECEIVED BY DATE WHITE - UNIVAR DRIVER COPY YELLOW - CUSTOMER COPY PINK - OFFICE COPY r "` .,Jy PREPAID ❑ COLLECT ❑ The undersigned, on behalf of Univar USA Inc., acknowledges receipt of the property described below, in apparent good order, except as noted (contents and condition of contents of packages unknown), marked, consigned, and destined as indicated, and agrees to transport or arrange for transportation of such property to its usual place of delivery at such destination. SHOW EMCEPTIONSMEMARKS BELOW, LIST ANY CONTAINERS OR MATERIALS RECEIVED NOT SHOWN. CREDIT WILL BE ALLOWED FOR ITEMS SUBJECT TO COUNT AND CONDITION VLHIiIED AT OUR PLANT. SERIAL NO. SERIAL NO. SERIAL NO. SERIAL NO. SERIAL NO. SERIAL NO, EMPTY CONTAINER CERTIFICATION I hereby certify that these containers are "empty" as that term is definad in the Environmental Protection Agency regulations, 40 CFR 261.7', and that they have been properly prepared for transportation under the regulations of the U.S. Department of Transportation, 49 CFR 173.29." COMPANY NAME: (please print) DATE: SIGNATURE. Univar USA Inc.