IMO DANGEROUS GOODS DECLARATION



IMO DANGEROUS GOODS DECLARATION

This form meets the requirements of SOLAS 74 chapter VII, regulation 5; MARPOL 73/78 Annex III, regulation 4 and the

IMDG Code, chapter 5.4.

|Consignor (name, address): |Reference Nbrs: 4500415820 |

|HARRIS AND FORD LLC | |

|> 6219 Wooster Pike | |

|> | |

|> Cincinnati, OH 45227 | |

|431 Battlefield Memorial Highway | |

| | |

|Building 211 | |

| | |

|Richmond KY 40475 | |

|9307 E. 56TH STREET |Carrier: Sea Star Line, LCC |

|INDIANAPOLIS,IN 46216 | |

|Consignee (name, address): |Name/Status, company/organization of signatory: |

|Diageo |Chad Martin / DG Coordinator / MMTPS |

|Estate Annaberg & Shannon Grove | |

|Kingshill, USVI | |

|Container packing certificate/vehicle declaration |Place & Date: Cincinnati, OH / 24-Sept-2010 |

|It is hereby declared that the packing of goods into the unit |Signature on behalf of consignor: |

|has been carried out in accordance with the provisions of 5.4.2.1 | |

|Ship's Name and Voy. #: |Port of Loading: |Special Instructions: |

|El Yunque |Jacksonville, FL | |

|Port of Discharge:San Juan |Goods Delivered As: |Type of Unit & Unit Nbr.: |

| No Qty., Type & Kind of Dangerous goods description* | Gross Weight |

|Pkgs. Size | |

|1 (4) Eurotanks UN 1824 Sodium Hydroxide Solution |27492.5 Kg EA |

|Containing 17,980 L Ea 8 , PG II, F-A, S-B |Total 109,970 |

| | |

|Additional Information: | |

|Emergency Contact Number: 001-703 527 3887 | |

|DECLARATION |Name/status, company/organization or signatory: |

|It is hereby declared that the contents of this consignment |Chad Martin / DG Coordinator / MMTPS |

|are fully and accurately described above by the proper | |

|shipping name(s) and are classified, packaged, marked | |

|and labeled/placarded, and are in all respects in proper |Signature on behalf of consignor: |

|condition for transport according to applicable | |

|international and governmental regulations. | |

* The following shall be specified: UN No., Proper Shipping Name, hazard class, packing group (where assigned) and marine pollutant; additional information when appropriate shall be placed after the dangerous goods description. For the purposes of the IMDG Code see 5.4.1.4

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