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STRAIGHT BILL OF LADING—ORIGINAL—NOT NEGOTIABLE SHIPPER NO._13OL502980N1 <br /> CARRIER NO. <br /> &IvkonnWrital Logfill-HaYntard CAR000217613 DATE <br /> CARRIER 'h SCAC <br /> TO CAD982444481 FROM CAD982485351 <br /> CONSIGNEE Filter Recycling Services, III SHIPPER <br /> CaNlans D10 Maintenance Lodi MS <br /> STREET 180 W.Monte Avenue STREET N5 E. Pine St <br /> P1301m 909.421-2012 PHOrM 209-9488-3723 <br /> DESTINATION 111001111111111glItIfin STATE CA ZIP 92318 ORIGIN Lodi STATE CA ZIP 9524( <br /> ROUTE VEHICLE NUMBER U.S. DOT Hazmat Reg. No. <br /> Number and Type <br /> of Packages HM DescriptiOn of ArtiCles <br /> �X (( 11r mulVAN"-tamV31, �lI <br /> O 1-IOt/YGSCts��- �:yVwF- +-bis — S <br /> FILTER RECYCL'VG SERVICES' RIALTO FACILITY, EP, <br /> OCAD982444481 HAS THE APPROPRIATE PERMIT(S) FOR <br /> AND WILL ACCEPT THIS WASTE AS SHIPPED, <br /> Remit COD to: a" "°"'or`°"d"'^ "'"' COD FEE: <br /> Address: ablpmam c ry be dhava rel to Me to COD AMT: <br /> wiMON remorse do Me consignor,Me mnsgre <br /> sign Me following sterad enC <br /> Tha tender shall not make delivery of this Prepaid <br /> City: State: Zip: shipmEJ <br /> ent wiMou �j Collect Ell payment of height and all other <br /> Iawlulchanges. <br /> NOTE:Where me rate is dependent on value,shippers are required to state specifically in writing the TOTAL CHARGES: <br /> agreed or declared value of the property.The agreed or declared value of the property is hereby FREIGHT CHARGES- <br /> specifically stated by the shipper to be not exceeding $ Per (Signature G Conslgnop ❑Prepaid ❑Collect <br /> RECEIVED,subject to individually Madmined rates or contracts Mat have been agreed upon in wiling bervieen the carrier and shipper,O applicable,othanvise to Ua rates,Geaailicatlons and rules Uel have been eslabliahetl by the carrier and are testable <br /> M Me shipper,on request and all applicable slate and federal regulations;the Property described above,in apparent good order,except as noted(contents and coMNon of contents of packages unktwwn),markeq consigby t and classical m indicated <br /> ble <br /> above which said company(the word company being understood!throughout Uis coseat as meaning any person or corporallon in possession of the property under the contract)agrees to carry to delivery at said destination,a on its mute,or otherwise to <br /> deliver U another eperformed <br /> tamer rouse to Sem castration.to <br /> It is mmuoly agreed as it each law, <br /> Mof all or any of saitl Property over all or any named of said mule to destination and as to each pant at any Oma interested In all or any of said Property Mat every <br /> service to be pedormetl hereunderarulshall be subject M all Me conditions not prohibited by law,wM1ether pdntatl or wriaen,In any <br /> contained!,including the conditions on Me back hard.which are hereby agreed to by Me shipper and accepted far himself and his <br /> assigns. <br /> NOTE:Liability Limitation for loss or damage In this shipment may be applicable.tee a U.S.C.1470$(c)(1)(A)and(e). <br /> This is to certify that the above-named materials are properly classified,described,packaged,marked,and labeled,and <br /> are in proper condition for transportation according to the applicable regulations of the Department of Transportation PER: <br /> SHIPPER: CARRIER: <br /> PER: PER: <br /> DAT . — <br /> EMERGENCY RESPONSE 8 0 0 424 - 9300 NAME OR CONTRACT NUMBER <br /> TELEPHONE NUMBER: OR OTHER UNIQUE IDENTIFIER: <br /> 111-BLC-04 12277(Rev.9/10) <br />