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TH I S '
<br /> MEMORANDUM Is an acknowledgement that a bill of facing has been issued and is not the Original 0111 of Lading, not a copy
<br /> or duplicate, covering the property named heroin, and is intended solely for filing or record,
<br /> Shipper' s No . . _.------ - - --
<br /> Carrier RAMOS ENVIRONMENTAL ENTAL SER IC S SCAC Carrier' s No .
<br /> RECEIVED, subject to individually determined rates or contracts that have been agrood upon in writing between the carrier and shipper, if applicable, otherwise to the rales, classifications and rules that have been
<br /> -i established by the carrier and are available to the shipper, on request: and all applicable state and federal regulations;
<br /> at date __ _ . from '
<br /> the Property described below, in good order, except as noted (contents and condition of contents of packages unknown), marked, consigned, and destined as indicated below, which said company
<br /> (the word companybeing understood throughout this contractus meaning any poison or corporation in Possession of the property under the contract) agrees to carry to delivery at said destination, if on its
<br /> t route, or otherwise to deliver to another carrier on the route to said destination. 11 is mutuallyagreed as to each carrier of. all or any of said Property over all or any portion of said route to destination, and as to
<br /> each party at any lime interested fn 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
<br /> contained, including the conditions on the back hereof, which are hereby, agreed to by ilia shipper and accepted tot himself and his assigns.
<br /> TO :
<br /> 3 (� � /�f t q � { FROM : 'r y ��
<br /> th✓+ t`4 l L. � { $� BL. i I
<br /> Consi nee Shipper +{ S t {t r
<br /> Street 401 WEST CHANNEL DRIVE Street
<br /> Destination BENICIA, CA Zip D51tOrigin
<br /> t
<br /> ) r ZI P , 1
<br /> Route
<br /> CALODMi
<br /> Delivering Carrier Vehicle Number U , S , DOT Hazmat Reg . No
<br /> ILe
<br /> A a t e
<br /> w NVA WA DigAIN D USED OIL FILTERS N/A a/A rP NJA
<br /> i
<br /> 7 p
<br /> ER CONITHA.CTOR HAN40S
<br /> NVIRWVI NTAL SERVICES
<br /> Remit COD to :
<br /> Subjeto bect to Suction r d to d , c li me COD FEE :
<br /> rift wtt recourse
<br /> dii vothe col anor , the COD AMT :
<br /> consigwithout r riall a is the consignor ,enol, the
<br /> Address : ccnsgn« ahailag m Ionw,mg Statement: Prepaid LJ
<br /> In" r fie M I not mak delivery of this
<br /> City . State : Zip ,: sl 'p t t ,nrho t p ym of height and rill $ t llEl
<br /> Collect r (t$
<br /> othn lawful chargee.
<br /> NOTE: Where the rate is dependent on value, shippers are required to state specifically in writing TOTAL CHARGES : FREIGHT CHARGES :
<br /> the agreed or declared value of the property. The agreed or declared value of the property is
<br /> hereby specifically stated by the shipper to be not exceeding $ Per (Signature of Consignor)isignor) $ ❑ Prepaid {� Collect
<br /> NOTE; . Liability limitation for loss or damage In this .shipment may be applicable. See 49 U.S.C:
<br /> 14706 c 1 A and BL 11 BY SHIPPER F1 BY CARRIER
<br /> • 1 1
<br /> lh5 i5 to u!rfily II•,tit d,e a;r.,� e n.am '! u,a4�risi., .rr , proP�-r,f .a . ,ilitd, d rnLi,c, tau k , ,7eti, 7h,tarkod
<br /> s rid Iabeied, and are in proper ccndnfon for iransport7hon accotd�ng to thc� apptiC.3P}ie r r;daiinn, rvf P 1 DRIVER'S
<br /> the Oepsdn =nl of Transpuitntimt. Fer } SIGNATURE;
<br /> ' NVtRi � E TA� SERVICESSHIPPE --
<br /> f t
<br /> PER ; DATE
<br /> PER : . , r :_ ,:; � DATE: � r .
<br /> EMERGENCY RESPONSE NAME `OR CONTRACT NUMBER
<br /> TELEPHONE NUMBER : (916) S7 `I 747 OR OTHER UNIQUE IDENTIFIER : -__ - — ----�
<br /> 969 ( Rev . 3117)
<br />
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