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Carrier No. <br />BELSHIRE <br />Rag% 1 .Q1 <br />&bled to Secton 7 of tha conaceet, fl this shipment to to be desvered to the comegnee without rococo. on Ike conskpof Ito, coruCconor shell 41n the <br />loUnvflost.tornent <br />lb. center and not make dogvery of 11113 sh!prnent sslthoul payment of <br />IreigrIt *no 01 ocher reed chrugea_ <br />• <br />(Scre.V• of CoroVvor) <br />rills riipping unaer Carborandr 'dhytheagent Shipper No, i1titWUAMA-1 , <br /> <br />AR 1.2 2013 <br />On Codecton Oerrrary sritmenu, kri;reCOD' must appear before condgneee name or as oMensbeProsbedln teen 430, Seol. <br />TO: <br />Consignee Belshire Yard <br />Street <br /> 25971 Towne Centre Dr. <br />FROM: <br />Shipper <br />Street <br />City Stockton <br />Chevron 206397 <br />666 West - <br />State CA <br />L HEALTH <br />VICES <br />zipcode 95206 <br />City Foothill Rangt.. CA 92610 Zip Code <br />24 hr, Emergency (*tact,Tel No. 800-424-9300 <br />Route Vehicle <br />Note/ <br />NM CHARGES <br />(For Carrier <br />Use Only) <br />No. of Units <br />& Contelneryype <br />TOTAL QUANTITY <br />(WeIgN, Volume, <br />. Gallons. eta) <br />Af-g <br />WEIGHT <br />(Subject to <br />Correction) <br />1 VP <br />BASIC DESCRIPTION <br />Proper Shipping Name, Hazard Class UN or NA Number, Proper Shipping Name, <br />UN or NA Number, Packing Group im Hazard Class, Packing Group <br />Non DOT Regulated Material <br />RATE <br />("Clean" Construction Debris) <br />Process: investigation or Remediation of Past <br />Contamination; <br />Parcel 2A; CEMC 206397/P66 041 <br />BESI tf: 216699 <br />PLACARDS TENDERED: YES ci NO I=1 <br />Note — (1) Whore the rate Is dependant on van" iNppers are required to W <br />adedicalinf in Writing tte agreed or declared Wale of the property, as totems.: 'The <br />' agreed or declared value of .the properly Is hereby specitcany stared by de sapper to <br />be ncd exceeing Per (2) Where tha apparietie but provisions specify • Imitation of the canteen tabley absent <br />a release or a value declaration by the shipper and the shIpper dose not release <br />the derner's febNly or declare, yak* the canter's llabilky shall bo rmaed to tho extent <br />provIdsay stern prov'slons, See MFG from 172. <br />{) CornrnocKlies meriting special or acketional care or &Janke In haneEng or stnelng <br />neat be en marked and packaged as to ensure rare transportation. Soo SocSon 2(0) of <br />tern 6O, totS of Lading, Freight Pets and Statements of Charges and Secton 1(8) of <br />the Contract Terra and Condrnore tore tat of auch aracirse <br />I hereby declare that the contents of .firts <br />Oon. eta ere ItOy and accurately <br />deerrthed obese by the proper stippMg <br />name and are classified, packaged, <br />marked and Libagediplacarded, and are <br />In all respects In proper condition for <br />transport according to appficable <br />treernatonal and nrnionel govenvnerttal <br />regulations. <br /> Signature <br />REMIT <br />COD, TO: <br />ADDRESS <br />COD Amt: $ <br />C.O.D. FEE: <br />PREPAID El COLLECT 0 <br />TOTAL <br />CHARGES <br />FREIGHT CHARGES <br />FRBOI-rt PilLeatO Chedrbox 1 chargm <br />somoptwhon boost area, he oot chadKed foiled <br />ROWED. sub)et to the clasalcs5ord end bura In seed on the dans d Se teas of Vs Bye Wing, <br />Sm Prnperly described above In apparent good order, except as rioted (contents end cordlion or con- <br />tents of packages unknown), marked, conegned, and destred on Ince-cated etove which sold carrier <br />(the Sal earner being understcod throughout trho =effect as neaclng any Fenton or corpora:Ion In <br />possossfon of to property under the centred) agrees to carry to to usual piece of Oehery et sold desd- <br />cafe°, Son its rade, otherrese to deliver to warner center our the note to sakl desttrafion. It Ix nibs- <br />aly agreed as to each carrier 04 00 or any of, said property over 01 01 any porton et re'd route le dee- <br />Gnaton and as to earn party at err/ fine Interested In net or any sakl pr perly, that mery senice to be <br />performed hereunder shall beset:114,ot tool the b111 of lading tonsil end comMorie to Sr. paremIng clas- <br />sification on the dee of ahkeent. <br />Stripper hereby certifies that he ts longer with al the lading teens and cendlons In the <br />governing classification and the sold terms arid conlcloras are hereby agreed to by the chipper and <br />accepted for Nrreell and his assigns. <br />SHIPPER Belshire o ehalf of CEMC CARRIER ELS-IiRE <br />PER PER <br />61)-10-i /17, <br />Permanent post-office address of shipper. 1,10,15 PIPACYCLI9 MICR <br /> <br />STYLE CF365-4 C2003 LABELAASTER Its (SOO) 621-5808 www.labeimaster.core <br /> <br />DATE