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THIS MEMORANDUM Is an acknowledgement that a bill of lading has been issued and is not the Original Bill of Lading,not a copy �f or duplicate,covering the property named herein,and is Intended solely for filing or record. SI1., 1��Shipper's No. r r1'R 132532-1 Carrier PHOTO WASTE RECYCM0 CO.,INC. Carrier's No. TO: SCAC Date 9-12-1 Consignee Pholeo Wage g FROM: °�'° C° Shipper MUS DIAGNOSTIC DAAGING Street 2980 Keener Blvd,Ste C Street 972 DEXTER WAY . Destination San Rafael,CA Zip 94901 Origin RIPON,CA Route Zip 95366 Vehicle Number L�U.S. DOT Hazmat Reg.No. PackagesNumber and Type I.D. of ,...., � s.`•�te.Sif-.��i�tfti•� aC si�r''A 47A(i�)L�r:1.: I @atfte 1lsatwai hu bees collected 8ncn ca wlitiatnaiiy Pmnpt tttslail Quotty ( ') Remit COD to: Subject to Section 7 of conditions,if this shipment is to be delivered to the consignee COD AMT: COD FEE: Address: without recourse on the consignor, the consignor shall sign the following statement: Cit The carrier shall not make delivery of this th Prepaid ❑ Y• State: Zip: shipment without 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: FREIGHT CHARGES: hereby specifically stated by the shipper to be not exceeding $ Per (Signature of Consignor) ❑ Prepaid Collect 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 b the carrier and are available to the shipper,on request;and all applicable state and federal regulations;the Property described above,in apparent good order,except as noted(contents and condition of contents of packages unknown marked,consigned,and destined as indicated above,which said company(the word company being understood throughout this contract as meaning any person or corporation(contents possession d the property under the contract)agrees to carry to delivery at said destination,if on its route,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 party 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!?y the shieper and acce ted for himself and his assi ns. NOTE:Liability Limitation for loss or damage in this shipment may be applicable.See 49 U.S.C. 14706 c 1 A and B. , This is to certify that the above ham materials are properly classified,described,packaged,marked •• s ❑BY SHIPPER BY CARRIER and labeled,and are in proper conditi n for transportation according to the applicable regulations of the Departm nt of Transportation. Iyer DRIVER'S SIGNATURE: SHIPP e — CARRIER: PE DATE: PER: .... 0ATL? EMERGENCY RE 0 SE NAME OR CONTRACT NUMBER TELEPHONE NUM R: OR OTHER UNIQUE IDENTIFIER: 209-BLC-Q 3 12461 (Rev.9/10) i i i AdAWonal Disposal Charges mq be assesed if t e waste do not conform faith P rof0e, TIME IN: i G ;TIME1 OUT: f Ra�ased— z-�-- Dat l ,r _ ReNeekMg Charge f 591: ►N!apply for any returned Items. Please remember to fill out the Hazardous Mate Label and attach it to the Ata'inier. if you nave any questions,piease aan't 11185 to to c811 us at 41 5-459-5WT. -'ramie you. i l l