For Recovered Refrigerants
Straight Bill Of Lading Short Form-Original - Not Negotiable
CARRIER/SHIPPER RECEIVED, subject to the classifications and lawful tariffs in effect on the date of the issue of this shipping order:
Check Carrier:   HMES – USF Holland   RDWY– Roadway   Other - ______________________
 Date*  Pick a date  
CUSTOMER PO#*:
 
SHIP FROM(COMPANY)*:
CONTACT NAME*:
PHONE*:
ADDRESS*:
 
CITY/ STATE/ ZIP CODE*:
E-MAIL*:
DISTRIBUTOR NAME :
(if not the same as SHIP FROM)

CONSIGNED TO: E.I. du Pont de Nemours and Company
c/o Hudson Technologies, Inc.
3402 North Mattis
Champaign, IL 61821
FREIGHT COLLECT Send Freight Invoices to:
DuPont c/o CASS Information Systems
P.O. Box 17606
Louis, MO 63178-7606
 Subject to Section 7 conditions of the bill of lading. If this shipment is to be delivered to the consignee without recourse on the consignor, the consignor shall sign the following statement:
 The carrier shall not make delivery of this shipment without payment of freight and all other lawful charges.
Per*.
(Signature of Consignor)
EMERGENCY CONTACT:
For a distribution incident (spill, leak, exposure, fire or accident) involving
any DUPONT (E.I. du Pont de Nemours and Company) shipment,
in USA call CHEMTREC at (800) 424-9300 (toll free for USA callers) or (703) 527-3887.
For incidents outside the USA, call local operator & request collect call to USA at 703- 527-3887.
For incidents in Europe, call DUCHEM HELP at (local international access code) ++ 44 (0) 845 600 6640.
DuPont’s registration number with CHEMTREC is CCN7442.
Materials
This is to certify that the above-named materials are properly classified, described, packaged, marked and labeled, and are in proper condition for transportation according to the applicable regulations of the Department of Transportation.
Important: Complete the following for cylinder swap and cylinder deposit processing. Discrepancies will be communicated after check-in at reclaim facility.
 

Placards Offered If Aggregate Gross Weight Exceeds 1,000 lbs.

   

Carrier Has Written Emergency Response Instructions

Pick a date    
Shipper’s Name* Date* Driver’s Name Date
 Remarks :

DuPont Legal – Commerce Council (last reviewed 11/22/05); Distribution Safety & Security Team (last revised 7/2/08)

FLPR Form - H-69736-16 Rev. 6/10