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SHIPP_', <br />I <br />i <br />DELIVERY DATE <br />JOB fflir 3D'r.{'.f <br />SHIPPER /CUSTOMER <br />POINT OF CONTACT <br />7f�7 .3nL7Ti I;-tYtt -)I_l-'t-' <br />�tvi r7l '..:f it?=th'.i:S <br />ADDRESS <br />PHONE N <br />CITY, STATE, ZIP <br />yyryry <br />,.:..9.. <br />1`10Ht i?.[.fS 13 } "�i_ ,i':y I> <br />- <br />CARRIER/TRANSPORTER '. <br />--- <br />PHONE# <br />it I3. >-_t�({�1,� <br />CONSIGNEE/FACILITY <br />POINTOF CONTACT <br />ADDRESS <br />— <br />PHONE# <br />CITY, STATE, ZIP <br />HM <br />- - -- <br />US DOT Description (Including Proper Shipping Name, Hazard Class, and ID Number) <br />- <br />Containers <br />Total <br />Quantity <br />UOM- <br />Np. .Type <br />A <br />IMi[XIBI AIM. Srl 1, ",. ,iR�, ikk 9 <br />35 �7if lii9 f�fHFYfA whufr t}iifR7l i' <br />.t <br />B <br />911TTE'WC ; op pS_€o, R.O.S. .O.S (�lbrilL �A:[i i#3r5.r. x,159 J. <br />ftil; ii�i$cRsi� �4i57E - SAt:EitaiT£a"!;➢ <br />� <br />r` <br />C <br />inrrrt4a J PiS(c €R^W; <br />f�C' � <br />; � <br />(: � a <br />i <br />D <br />Special Handling instruction and Additional Information: <br />tj 1229240, PsJAM-111i NTILEH RE(A 1:': 9:r S'ti ti r.f.' 3) � f:I;;i. <br />r.hr )'fi_i- <br />IF. ti19D`ii{-11 WE RECON tltl <br />Placards Provided YES NO <br />SHIPPER'S CERTIFICAI ION: "I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are .classified <br />Packaged marked and labelled/placarded, and are in all respects in proper condition to(transport accordigg to applicable international and national governmental regulations" <br />also certiy that all times listed above are true and corroct. <br />M1 <br />(SHIPPER) fjg,JTO/RTYPENAME.._ ( SIGNATU E -� <br />�' <br />YEAa <br />i >iz <br />//DyynonTa <br />//Dur <br />X <br />(CARRIER R SRORTER) PRINT OR TYRE NAME SIGNATURE' <br />MONTH <br />our <br />t�u <br />X(CONSIGNEE/FACILITY) <br />PRINT OR TYPE NAME SIGNATUREI <br />MarvinDAY <br />YeARI <br />X. X <br />SHIPP_', <br />I <br />i <br />