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Lj <br />Mil IPPING R <br />SHIPPER <br />DELIVERY DATE <br />JOB 4 <br />'ER / CUSTOMER <br />POINT OF CONTACT <br />ESS <br />PHONE# <br />STATE, ZIP <br />W'WV`-N' <br />IER/TRANSPORTER <br />10J,ilf IMNIS'MfAe.: <br />. ? 'Oh <br />PHONE# <br />� <br />IGNEE FACILITY <br />POINT OF CONTACT <br />ESS <br />AVENIP'-' S(X"'H <br />PHONE# <br />1 'j P A0,44 <br />STATE, ZIP <br />US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />Containers <br />No. <br />No. Type <br />Total <br />Quantity <br />Handling Instruction and Additional Information: <br />Rg� WTHS ii E;? 13) SfTs: <br />s Provided YES- NO <br />2.'6'j W tCNIANNAMS. �19AV, CA, F)4.�-U KK J;7Y? PILLF.R. C0 �?08M <br />:R'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, <br />and labeled, and are in all respects in proper condition for transport by highway, vessel, and rail according to applicable international and national government regulations. <br />ER) PRINT OR TYPE NAME <br />SIGNATURE <br />X <br />MONTH <br />DAY <br />YEAR <br />':c-R/TRANSPORTER) PRINT OR TYPE NAME <br />SIGNATURE <br />X <br />MONTH <br />DAY <br />YEAR <br />'IGNEE/FACILITY) PRINT OR TYPE NAME <br />SIGNATURE <br />X <br />MONTH <br />DAY <br />YEAR <br />SHIPPER <br />