Okaloosa County BOCC — August 6, 2013 — shipping document — reading text

(Uniform Domestic Straight Bill of Lading, adopted by Carriers in Official, Southern, Western and INTERNAL USE: (GHECK ONE) wa 347932701. Pee cer ier! Fo oc, 2, . prey 4. illinois Classification territories, March 15, 1922, as amended August 1, 1930 and June 15, 1941,) 4] SHIPPING DOCUMENT STRAIGHT BILL OF LADING — SHORT FORM — ORIGINAL ~ NOT NEGOTIABLE [| MDSE RETURN REPORT CUSTOMER P.O. NUMBER ~ R ag RECEIVED, subjéct to the contracts, classifications, and tariffs in effect ([] contaNeR RETURN REPORT FOS L764us#259 on the tiate of he issues Bill of Lading. Page 1 of . MOBILE, AL SLS: 1-MC ~ ~ 3 i r Le, f : 02 C ORDER DATE 59-SEP-2013 Harcros Chemicals Inc, EST IMATED SHIP DATE DATE SHIPPED ‘The proparty decscibed below, in apparant gocd order, except as noted (contents and condition of cantants of packages 0 3 nad 0] Cc T _ 2 0 1 3 u }, marked, igned, and destinad as indicated below, which sald canifer {the word carrier being understood SO; vA sz A vA S throughout this conlract as meaning any person or corporation in jon of the prop under the contract) agrees A fo carry to Its usual plece of dafivery at said destination, if on ifs route, ofhervise.to deliver to another carder on the Lf. WA route ta said destination. itis mutuelly agreed, as to each cartier of all or any of said property over all-or any pertion of said route to destination, and as to each party at any tirte interested ty all or any of said property, that every service Subject ip Section 7 of ito if this shi is to be. tothe to be performed hereunder shail ba subject to all the ferms and conditions of the Uniform Domestic Straight Bil of Lading 7 xéthout recourse on the consigiior, the consignor shall sign the folowing statement. set forth (4) in Uniform Freight Classification in alfect on the date hereof, if this is a rail or a tail-water shipment, or The canter shail not make delivery of this shipment séthout payment of freight and all {2} in the applicable -metor carrier classification or tariff if this is a motor carrier shipment. - . . Shipper hereby certifies thai he is familiar with ail the terms and conditions of the sald bil.of lading, Including ofher avwful charges. S owe ane bac erat ut ohne danofentencrentamicanreme Sevspraanarnesiemnos | AAR CRC een Hareros Chemicals Ine. CHEMICAL GROUP (SIGNATURE OF CONSIGNOR} ONSIE : ; GHT CHARGES, COD. ONSIGNED TO: OKALOOSA COUNTY IF FRE! RGES ~ ARE TO BE PREPAID, RUSSELL STEVENSON PLANT WRITE-OR STAMP HERE, COLLECT ON DELIVERY 3182 HWY. 98 WEST "TO BE PREPAID.” REMITTO: HARCROS CHEMICALS INC MARY ESTHER, FL 32569 fo Be Prepa Ph: nna-fOb0-n0n00 ARRERIARCROS TRUCK 05991960 09083822 Act? “1. CONTAINER] HE p SOMTAINER | DESCRIPTION O.OF PKGS. ORDERED | EMERGENCY CONTACT: CHEMTREC 800-42 HARCROS CUSTOMER NUMBER: CCNIO1 RAK KA KR AKA KR HKRAKRAKAR KA KRHA KRKA KR NHR RQ Cy UNTOL?, CHLORINE 2.3 (5.1, 8) POISON INHALATION HAZARD HAZARD ZONE BO. HARINE POLLUTANT ** CHLORINE GAS ** NMFC @ 85900-2 CLASS 175 Chlierine 20004 Cylinder-Harcros Q5847 0003860 ¥ ate 06 CAN ONLY BE SHIPPED ON A HARCROS HARCROS WILL BE CLOSED FOR PHYSIC INVENTORY ON FRIDAY, SEPT 27,2013 Total Weight 25~Sep-13 ~ 02:19 PM CST 250 2 )5 3400 7509? HARCROS WILL ACCEPT COMPANY CHECK PLACARDS PROVIDED OR APPLIED id ‘GROSS/ NET WEIGHT. A~-~93006 b2 ea RR AK asOoLBs rRUCK. AL. 6800TOT pe doocooooo0sood Oj C NOT APPLICABLE NOT ACCEPTED 2.2- NON-FLAMMABLE GAS 2.3 POISON GAS 3~FLAMMABLE 4.4 — FLAMMABLE SOLID 4.2 — SPONTANEOUSLY COMBUSTIBLE 4.3— DANGEROUS WHEN WET 5.1—OXIDIZER 5.2— ORGANIC PEROXIDE 6.1 — POISON 8 ~CORROSIVES 9—CLASS 9 DANGEROUS COMBUSTIBLE MARINE POLLUTANT 4 WHEN APPLICABLE EMERGENCY RESPONSE GUIDE ON BOARD? iS THE YES DRIVER INTHALS HARCROS BULK DELIVERIES Lgeanry THAT CONNECTIONS TO OUR CORRECT AND READY 1 OF COMMODITY NAMED AND WILLACCEPT THE NEf WEIGHT AND OR VOLUME OF THIS DELIVERYIN FULL AND STORAGE TANKS ARE FOR URL OADING CUSTOMER SIGNATURE ORDER FILLED BY This is tc certify thal the above named fais are properly classified, di NOTE: Where rate is dependant on value the shipper hereby specifically states the declared vatus of such prop tobe not O: Mark with “X” In this column to dest i fous Material as defined in Tite 49 of the Code of Federal Regulations, ding $2.30 per pound. Hareips Chemicals Inc, Shipper, X Sang x Sha : — fy fea d, matked, and fabsied, and are in proper condition for transporlafion, according to the applicable regulations of the Depariment of Transaortion. LL oyet PEYPPERILOADER SIGNATURE 15047 (40/09) Permanent Post-Office Address of Shipper: HOBILE, AL 36610 we 4 CUSTOMER PRINTED SIGHATBRE 7 EL EGR A ERG STOMER SIGNATURE (/ DRIVER SIGNATURE ORIGINAL / BRANCH IN CASE OF EMERGENCY CALL CHEMTREC AT (800)-424-9300 1