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SHnrIT F(i-Original-Not Negotiable 36 (t'7 Shipper's No. PHILLIP WEST INDUSTRIAL SERVICES INC. er) SCAC. Carrier's No. ED,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 estcolished by the"rief and-are aaailehle,tcatMe.s+tipper\on request;and all applicable state and federal regulations; BENICIA) at 3 VVbJI ltllYl�IVCLRv date NE from the Property described below,in apparent good order,except as noted(contents and condition of contents of packages nknown),marked,consigned,and destined as indicated below which said company (the word company being understood throughout this contract as meaning any person or corporation in possession of 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 by the shipper and accepted for himself and his assigns. TO: (Mail or street adCtlB$S o�c{NfEnp fp({lj{ M"tification only.) FROM: SERVICE STATION MARTINEZ YREF1IJNl.1ERY Consignee Shipper 1801 MARINA VISTA 2375 Grantline Road Street Street MARTINEZ, CA. 94303 Tracy, CALIFORNIA Destination Zi Ori in Zi Route: So i?o Delfverin6 Carrier Trailer Initial/Number U.S. DOT Hazmat Reg. Number No.of packages HM Description of articles,special GASOLINE 1VIIXTURE /a,27 ��Z, ERG#128 -ontams-water-with-<-10%-oi-l-bear-in ateria s-and-m y-includ xt-r-act - Groundwater from service station facilities that would be non-hazardous under ---- -- -------�------Federal-arid staffwaste classification--ritena- -SO-P_IIS-Martinez-Refinery — Receiving Gate to direct driver to the Effluent Treatme t Plant Cliperator 0202) --mor-offloading-directions— - - SAP / INCIDENT#: 97471967 RIPR# 68317 — - -- GRA- - - ----- — - -— - ----- - RemitG.O.D. to: A senile(t1 Section 7 of to the°"=,If this C. O. D. FEE: l COD AMT: shipment Is to be delivered to the consignee Address: I without recourse or the consignor,the El shall sign the following statement: Prepaid The Cartier shall not make delivery of this City:- A State: Zip, shipment without payment of freight and all Collect ❑ ,.7 other lawful charges. Vde.- ere eatestl endentonvalue,shippersarerequiredldslatespedfcallylnwdtirgNeagreetlordedaretivalueoflhepmpedy. Charges Advanced FREIGHT CHARGES rhe a led or d dare v ue of the property is hereby pecir Ilyslal byth hipper to r note.—d,,g perg F1Prepaid El Collect (Signature Of consignor) NOT:Ll.blll Llmlla. fs or damage In thls shipment maybe applicable.See 49 U.S.C.14706(c)(1)(A).nd TIYs ry Ihal e-na .a mal.dals are property cla.amed,d—into,d,paclaged.m"ed and labeled,and sl.n '1 1 YES NO-FUR lS BY AR IER prop r con 1 ration acording to In..pplicable regulations or Ne e.padment of ToarZponanoo, ' 1 1 Per DRIVER'S SIGNATURE S IAL INSTRUCTIONS: S. .R: ,5_ !L RG S CCS CARRI PEr,. DATE: d6 PER: DATE: EMERGENCY RESPONSE TELEPHONE NUMBER: gOC/ Permanent post office address of shipper Monitored at all times the Hazardous Material is in transportation including storage incidental to transportation 29-BLS-C3 969(Rev.11/04)