MULTIPLE CONSIGNORS SAMPLE FORM

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					                                                   MULTIPLE CONSIGNORS SAMPLE FORM                                                                         BC 12345-6




                                                                                  LT 1234
MULTIPLE CONSIGNORS - SEE ATTACHED FORM.                 Quick Trucking Company

                                                         444 Front Street        Uptown        BC            V6F 7G8
                                                         quicktrucking@uptown.ca                      250 777-7777

                                                                                         3456 - DW                       BC




Waste Processors Inc.                RS 4321
1000 Side Avenue Sidetown      BC          V5D 6E7
wasteprocessors@sidetown.com        250 888-8888
                                                          TOM BROWN                                  250 777-7788
same as above
                                                         0   9     0   2     1    5


                waste oil                          N/A       N/A       N/A            10,500   L     01        02        L




                                                                                                                                                    IN CASE OF EMERGENCY CALL:
                                                                                                                                        X           ABC EMERGENCY CENTRE AT 1-800-999-9999



                                               JOHN DOE                                                   250 999-9999                            X
                                                                                                                              0 9   0   2   1   5 1 0 :3 0 0 9         0     2    1    5