Road Waybill

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Road Waybill

Freight Order No. 61000000334 610000003304

Shipper/Exporter Planned Ship Date:

Carrier:

Tax ID#:

Vehicle No.:
Mode of Transport: Road

Special Instructions:

THE SHIPPING ORDER must be ligibly filled in, in ink, in indelible Pencil or in Carbon, and retained by this Agent.

RECEIVED, subject to the classification and tarrifs in effect on the date of issues of this Original Bill fo Ladding,

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the property desribed below, in apperent order, except as noted (contents and conditions of contents of package unknown), marked, consigned and
detined as indicated below, which said carrier(the word carrier being understood throughout as any person or corporation in pessession of property under
contract ) agrres to carry to its usual place of delivery at said destination, if on its route, otherwise to deliver to another carrier on route to said
destination.It is mutually agreed, as to which carrier of all or any of said property over all or any portion of the said route to destination, and as to each
party at any time interested in qll or any of the said property, that every service to be performed hereunder shall be subject to all the terms and conditions
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of the Uniform Domestic Straight Bill of Ladding set forth(1) in Uniform Freight Classification in effect on the date hereof, if this is rail or rail-water
shipment, or (2) in the applicable motor carrier classification or tarrif is this is a motor carrier shipment .
Shipper hereby certifies that he is fmilier will all the terms and conditions of the said bill of ladding,set forth in the classification of tarrif which governs the
transportaion of the shipment, and he said terms ad conditions are hereby agreed to by SHipper and accepted for himself and is assigns.
This is to certify that herein named materials are properly classified, described, packaged,
marked, and labelled and are in proper condition for transportaion according to the Signature __________________________
applicable regulations of the Department of Transportaion.
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CUSTOMER ORDER INFORMATION
Delivery Container Seal Consignee DESTINATION No. of Del Gr. ADDITIONAL SHIPPER INFO
No No No Pkgs. Wt.
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Total

CARGO INFORMATION
Delivery Emergency Total Product Product Net Expl Returned Returned
No. DESCRIPTION OF GOODS Response Units Gr.Wt Gr. Vol Mass/Qty Qty Net Expl
Guide No Mass/Qty

Total

THIS TRUCK HAS BEEN PROPERLY PLACARDED/SEALED: ES INC.____ DR_____

FOR CHEMICAL EMERGENCY, SPILL, LEAK, FIRE, OR ACCIDENT CALL PLACARD APPLIED:
CHEMTREC- DAY OR NIGHT IN THE USA CALL 800-424-9300 OR
703-527-3887 IN CANADA: (ERP# 2-1510) 877-561-3636 OR 703-527-3887

Shipper;s Name (Please Print): Driver;s Name (Please Print):

Signature Date Signature Date


Road Waybill

Freight Order No. 61000000334 610000003304

Shipper/Exporter Planned Ship Date:

Carrier:

Tax ID#:

Vehicle No.:
Mode of Transport: Road

GHS/WHMIS SDS documents available

Website: www.oricaminingservices.com Email: sds@na.orica.com

Phone: 1-855-26-ORICA (1-855-266-7422)

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