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STRAIGHT BILL OF LADING -sr7 FORM-Original-Not Negotiable tPW 2y-7 -f�r 6e <br /> - Shipper's No. <br /> f 361 j_� <br /> PHILLIP WEST INDUSTRIAL SERVICES IN <br /> 'tier) CAC. Carrier's No. <br /> I IVED,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 <br /> .dished by the 395r"srtJJe tathe,shipp�r,p{i request;and all applicable state and federal regulations; <br /> t1H1V1V1✓L IVJ BENICIA <br /> at , date from <br /> the Property described below,in apparent 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 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,A on its <br /> 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 <br /> 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 <br /> contained,including the conditions on the back hereof,which are hereby agreed to by the shipper and accepted for himself and his assigns. <br /> TO: (Mail or street addgpqFL1ordffpWr(3bgLT Df aotification only.) FROM: SERVICE STATION <br /> MARTINEZ REFINERY U� <br /> Consignee Shipper <br /> 1801 MARINA VISTA 2375 W GRANT LINE RD <br /> Street MARTRIEZ, CA 94303 Street <br /> Destination Zip Origin Zi <br /> Route: <br /> Delivering Carrier Trailer Initial/Number U.S. DOT Hazmat Reg. Number <br /> Description <br /> -rate (or exempiion) <br /> GASOLINE MIXTURE 3 UN1203 II <br /> ERG#128 <br /> I Contains water with<10% oil bearin materi s and m y include extracted <br /> --gr-0undw,attf om-se viee-statim-f-ec' 'ties tira would n�rl=lidous rider <br /> federal and state waste classification riteria. <br /> SOP US Martinez Refinery <br /> _ -- Receiy ngGate_to_direct_driver-to-the en reatrne t-Plant--- perator- 3202- -------For off loading directions. <br /> --RIPR# cjo Y--- --- — I if A"f' 11 r_1 <br /> �07 — <br /> s"bill IO SectioC0DFEE <br /> n 7 of conditions,it 1115 C. . D.Remit C.O.D. to: shipment is to be delivered to the consignee a <br /> COD AMT: without recourse on the consignor,the <br /> Address: consignor shall sign the following statement Prepaid El <br /> The caller shall not make delivery of this ElCity: State. Zip. shipment without payment of freight and ail Collect <br /> oths. <br /> "oe.-where the rate is°epeidentwvalue,d,ippetsammquimdtenalespeakodyinwd°ngthe agreed ordeclared valmofthe propeny er lawful charge <br /> Charges Advanced FREIGHT CHARGES <br /> The agreed or declared value of the property is hereby <br /> spec6lalty stated by the shipper to be not exceeding per $ (Signature of consignor) 1 0 Prepaid El Collect <br /> NOTE biblety Laneation for loss or damage In this shipment may be applicable.sae 49 USX,Uns(c)(1)(A)oral(13). <br /> This is to crap'met the abo.o-named malenetc are pmpedy casstr d,descreea,packaged,mane w iaealea,and are In " LiYES Ll NO-FURNISHED BY CARRIER <br /> proper cmdalun forbanayodanon accorxhng to cite apprvanie mgaleeore of me oepammert of Tramponaron. Wagm 14 1 1 <br /> Par DRIVER'S SIGNATURE: <br /> SP`­—IAL INSTR TIONS: <br /> Si :R: CARRIER: <br /> ol <br /> PER: DATE: —p — � PER: DATE: <br /> EMERGENCY RESPONSE <br /> TELEPHONE NUMBER: <br /> •Dent post office address Ip r Monitored at all times the Hazardous Material is in transportation including storage incidental to transportation(§172.604). <br /> 29-BLS-C3 969(Rev. 11/04) <br />