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T Const nee: FROM Shipper:of 01I V {{---- -� Street C:: �!` ! DOD 6 2 j Destination Zip Code Emergency Response Phone No. Route: Vehicle No. j No.un HM Kind of Package,Description of Articles,Special Marks and Exceptions °Weight(Sub.to Cori RATE ✓ CHARGES r V � II REMIT D.D.D. FEE: C.D.D.SS C.O.D. PREPAID ❑ $ CHARGES: $ TOTAL ADDRESS COLLECT [I a If the shipment moves between NOTE: Where the rate is dependent on value, Subject to Section 7 of conditions. N this shipment two porta by a carcier by water, the shippers are required to state specifically in writing is to be dolivered t, rhe consignee without recourse FREIGHT CHARGES law requires that the bill of lading the agreed or declared value of the property. on the consignor, the consignor shall sign the shall state whether R is 'carrier's The agreed or declared value of the property is following statement Check Appropriate Box: or shipper's weight'. hereby specifically stated by the shipper to be not The carter shall not make delivery of this shipment exceeding without payment of freight and all other charges. IS per E] Freight prepaid � Collect (Signature of Consignor] RECEIVED, sub ect to the classifications and lawfully filed tariffs in effect on the data of the issue of receipt by the carrier of the property described in the Original Bili of Lading. the property descried above in apparent good order.except as noted(contents and condition of contents of packages unknown],marked,consigned and coached as Indicated above,which ! said carcier(Me ward 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 destination, if on its route, otherwise M deliver to another carrier on the route to said destination. It is mutually agreed as m each carrier of all or any of, said property over all or any portion of said route to destination and as to each party at any time interested in all or ar of said property,that every service to be performed hereunder shell be subject to all the terms and conditions of the Uniform Domestic Straight Bill of Lading set forth(1)in Uniform Freight Classifications in effect an the data hereof,if this is a rail or a railiwater shipment,or(2)in the applicable motor carrier classification or tariff if this is a motor carter shipment. Shipper hereby catches that he is familiar with all the terms and onditions of said bill of lading, set forth in the dassification or tariff which governs the transportation of this i - sh�mant,antl the said terms end conditions ere hereby agrged M b e shipper an a ceptetl for himself and his assigns, `'is is to certify that the above named materiels are ppo. a9sred. deacr" ed packaged, marked and labeled, and are in proper condition for transportation, according W the }able regulations of the Department of Transportation., j � r I Shipper, Per , '/ Agent, Per _ +Mark with'X"to designate Hazardous Material as defined in Tide 49 of Federal Regulations. / For further details on TRANSPORTING f HAZARDOUS MATERIALS see Federal j FORM No.3e41 1 Regulauons 4^CFR, Par[ 172 Printed in the U.S.A.