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This Shipping Order must be legibly tilled in, in Ink indelible Pencil, or in RLL Lt.l v LLQ pp 9 Carbon, and retained by the agent Shipper No. Page off (Name of carriE On Collect Collect on Delivery shipments, the lefters"COD" must appear before consignee's name or as otherwise provided in Item 430, Sec. I. TO: Consignee6��jr,�y Street City State, G'' Zip Coder 215f/, IT � NOV 0 4 2013 Carrier No. Date eZ / FROM: Shippgr Street �2�!/ Z City -S`� State Zip Code 24 hr. Emergency Contact Tel. No Route Vehicle Number No. of Units H M BASIC DESCRIPTION TOTAL QUANTITY WEIGHT CHARGES Proper Shipping Name, Hazard Class UN or NA Number, Proper Shlpping Name, (Weight, Volume, (Subject to RATE (For Carrier & Container Type UN or NA Number, Packing Group °r Hazard Class, Packing C}wup Gallons,Correction) Use Only) __ 7s" I 141 PLACARDS TENDERED: YES = NO O REMIT C.O.D. TO: Note — (1) Where the rate is dependent on value, shippers are required to state I hereby declare that the contents of this ADDRESS specifically in writing the agreed or declared value of the property, as follows: 'The consignment are fully and accurately agreed or declared value of the property Is hereby specifically stated by the shipper to described above by the proper shipping be not exceeding per name and are classified, packaged, (2) Where the applicable tariff provisions specify a limitation of the carrier's liability absent marked and l re classic labelled/placarded, and ere COD Amt: $ e release or a value declaration by the shipper and the shipper does not release in all respects in proper condition for the carrier's liability or declare a value, the carrier's liability shall be limited to the extent transport according to applicable Subject to Section 7 of the conditions, It this shipment is to be delivered to the provided by such provisions. See NMFC Item 172. international and national governmental conslgnee without recourse on the consignor, the consignor shell sign the (3) Commodities requiring special or additional care or ahentlon in handling or stowing regulations. follow ng staters shell not make dative of This shipment without must be so maked and packaged as to ensure safe transportation. See Section 2(e) of Irelghl end all other lawful charges. delivery p payment of Item 360, Bills' of Lading, Freight Bills and Statements of Charges and Section 1(a) of the Contract Terms and Conditions for a list of such articles. Signature tageawre of Canelanwl RECEIVED, subject to the classifications and tariffs in effect on the date of the issue of this Bill of Lading, the property described above in apparent good order, except as noted (contents and condition of con. tents of packages unknown), marked, consigned, and destined as Indicated above which said carrier (the word carrier being understood throughout this contract as meaning any person or corporation In possession of the property under the contract) agrees to carry to Its usual place of delivery at said desli. nation, if on its route, otherwise to deliver to another carrier on the route to said destination. it Is mutu- ally agreed as to eachdarder of all or any of, said property over all or any portion of said route to des - SHIPPER PER C.O.D. FEE: PREPAID ❑ COLLECT ❑ $ FREIGHT CHARGES 1EIGHTPREPAID Check box 11 charges cept when box at are to he ihl Is checked ❑ ooll.d tination and as to each party at any time Interested In all or any said property, that every service to be performed hereunder shall be subject to all the bill of lading terms and conditions in the governing clas- sification on the date of shipment. Shipper hereby certifies that he is familiar with all the lading terms and conditions in the governing classification and the said terms and conditions are hereby agreed to by the shipper and accepted for himself and his assigns. CARRIER PERk- DATE -A/- Permanent /- Permanent post -office address of shipper. STYLE F365-3 02003 LABELMASTER® (800j621-5806 www.labelmaster.com PRINTED ON RECYCLED PAPER PRINTEe WITH USING SOYBEAN INK SOY INK