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BILL OF LADING <br /> 3909 Park Road, Suite D <br /> NVIRONMENTBenicia, CA 94510 <br /> GROLTf?,TSERVICES (877) 748-3040 <br /> .j.e+§',j�-*�>j M2s't i::3'r`,c,€ ,,,-_r`�?9'r�.c -i�v'°g <br /> Western RegioA <br /> DEUVERY DATE JOB ; ; ; §� <br /> SHIPPER/CUSTOMERPOINT OF CONTACT <br /> SHIKTU, 01L <br /> -4 4AWYMN' <br /> ADDRESS yy PHONE#t. ' <br /> 2575- C`.:.'+'�..�Ls'.I 41°t yi..;nl3 <br /> CITY,STATE,ZIP <br /> CARRIER/TRANSPORTER PHONE# <br /> /«".. <br /> `.A <br /> CONSIGNEE/FACIUTY POINT OF CONTACT <br /> ADDRESS.999,-? p j PHONE# <br /> _ Awus ii./t .i'S.f,aw <br /> CITY,STATE,ZIP <br /> e ro �' - V71j ?A. <br /> rsE <br /> `tr?i Y <br /> B <br /> C <br /> D <br /> Special Handling Instruction and Additional Information: <br /> qty +. n l t - 2r" ?,Rc gk hl� q' it -a: v Z rl <br /> �i4tt ��'"t'+$57�.us i 5r:.�°r s' w ct;\� f�� <br /> ���f� >�+°t`�.l ��`�'¢��. .j754 t=/5...�f 'f• ?e �,�r'!� � F"".�iyy?` '�t:� ��tp�t; <br /> Placards Provided YES NO Emergency Phone <br /> ,_!(877) 748-3040 <br /> SHIPPER'S CERTIFICATION:i Hereby declared that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> marked,and labeled,and are in all respects in proper condition for transport by highway,vessel,and rail according to applicable irnemational and national government regulations. <br /> (SHIPPER)PRINT OR TYPE NAME. ,•i. ' =; i SIGNATURE � '� Mormi DAY YEAR <br /> /• '.} X <br /> (CARRIER/TRANSPORTEA)PRINT OR TYPE NAME' SlCiNATUF(E: + MONTH DAY YEAR <br /> C <br /> (CONSIGNEE/FACILITY)PRINT OR TYPE NAME .f J' J/ SIGNATUREfi F r P-TH DAY YEAR <br /> Form#PSC-201-RV 6/04 <br /> SHIPPER <br />