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P PI N R E R mist be legibly filled In,in ink,In Indelible Pencil,or in LIP Carbon,and retained by the Agent. Shipper's No. Carrier IROS EINVIRONMENTKL SERVICES SCAC Carrier's No. 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,classifica#ions and rules that have been established by the carrier and are available to the shipper,on request;and all applicable state and federal regulations; at date from ny the Property described below,in apparent good order, except as noted(contents and condition of contents of packages unknown), marked,consigned,and d to cared r to delivery atsaiddetstinationch said�if na is (the word company being understood throughout this contractus meaning any person or corporation in possession of the property ) 9 carry to or otherwise to deliver to another carrier on the route to said destination. it is mutually agreed 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 patty at any time interested in all or any of said Property that every service to be performed hereunder shall be subject to all the conditions not prohibited by law, whether printed or written, herein contained,including the conditions on the back hereof,which are hereby agreed to by the shipper and accepted for himself and his assigns. TO: FROM: ConsigneeGi Sits' TRIS Ship er U ,, Street 401 WEST CHANNEL DARIVE- Street co, Z L__7 CA r y Zi �5 Destination Zi Ori in �� t�� Route Delivering Carrier Vehicle Number U.S. DOT Hazmat Reg. No. Weight Class or Number and Type I.D. Hazard HM Description of Articles 11 - (subject of .• - Number N/A NIA DRAINED USED CIS. FILTERS N/A NIA ^yA W&.11 go 7 s►t --- -.,_ - ER_ ITiI CT0R.MMC5_.._ _ EN'VI1c0W#tNTAtSERVI0ES Remlt COD to: Subject to Section 7 of conditions, it this shipment to rs delivered to c the consigneeC11 AMT. C®® ��` Address: without recourse on the consignor, the consignor shall.sign the following statement: City: State, The Car shall not make delivery of this $ Prepaid ❑ Zip: shipment wfthout payment of freight and all NOTE: Where the rate is dependent on value,shippersother lawful charges. Collect ❑ are required to state specifically in writing the agreed or declared value of the property. The agreed or declared value of the property is TOTAL CHARGES: hereby specifically stated by the shipper to be not exceeding $ er FREIGHT CHARGES: NOTE; t_iability Limitation for loss or damage in this shipment may be applicable, See 49 U.S.0 (Signature of Consignor) 14706(c) t(A)and(B). ❑ Prepaid ❑Collect This is to certify that the above-named materials are properly A p open classified, described, packaged, marked ' ❑BY SHIPPER ❑BY CARRIER and labeled, and are tri proper condition for transportation according to the applicable regulations of the Department of Transportation. Per E DRIVER'S SHIPPER: ' v W IL 'C-1 t,1 �.� t�G SIGNATURE: ,.� ,� <. , - CARRIED : AieIRC �iITARI` PER: DATE: PE fES DATE: " EMERGENCY RESPOZ�: �((1911 SE -�-----x TELEPHONE NUMBE �17 NAME OR CONTRACT NUMBER OR OTHER UNIQUE IDENTIFIER: 969 (Rev.3/17) Agent must detach and retain this Shipping Order and must sign the Original all[or Ending.