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i,IX?i tiah tai]% '•':^.- L. r .., ..._ / -. , _ ...,.._ Street Destination Zip Code Emergency Response Phone No. Route: Vehicle No. , raw , •, No.UmlPping ` Kind of Package,Description of Articles,Special Marks and Exceptions *Weight(Sub,to Com.) RATE v/ CHARGES HIM Spent Lead Acid Batteri,ta Broken !,sad ;acid Battories i REMIT C.O.D. FEE: C.O.O.TO: Aft El PREPAID ❑ $ $ + ' ADDRESS COLLECT e H the shipment moves between NOTE: Where the rete is dependent on value, Subject to Section 7 of conditions, if this shipment two ports by a carrier by water, the shippers are required to state specifically in writing is to be delivered to the 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 it is 'carrier's The agreed or declared value of the property is following statement Check Appropriate Box: or shippers weight', hereby specifically stated 4 the shipper on be not The carrier shall not make delivery of this shipment exceeding without payment of freight and all other charges. $ per E] Freight prepaid E] Collect (Signature of Consignor) RECEIVED, subl'ect to the classifications anti lawfully filed tariffs in effect on the data of the issue of receipt by the carrier of the property described in the Original BIII of Lading, the tents propercy described above in apparent good order, except as noted(conand condition of contents of packages unknown), marked,consigned.and destined as indicated above.which said tamer(the word carrier being understood throughout the contract as meaning any person or corporation in possession of the property under the contract)agrees to carryto in usual place of delivery at said destination, if on its route,otherwise to deliver to another carrier on the route to said destination. It is mutually agreed as to each terrier of all or any of, said property over all or any portion of said route to desdnetion and es to each party at any time interestetl in alt or any of saitl property,that every service to be performed hereunder shell ba subject to all the terms and conditions of the Uniform Domestic StraighC Bill of Lading set forth[7)in Undorm Freight Clessrficeuons in effect on the date hereof, 'rf this ie a reil - 1'"'or grail-,nater shipment,or(2)In the applicable motor carrier cleseificetlon or tariff if this is a motor terrier shi mens. -'- - - Shipper hereby cert'rfies chat he is familiar wnh all the terms end conditions N the said bill of lading, set forts in the classification or tariff which governs Ne transportation of this shi ment,and the said terms and conditions are hereby egreetl to W rhe shipper end accepted far himseR and his assigns. his is to certify that the above named materiels are property c assifed, describetl, packaged, marked and Iabele , and ere in proper condition for transpurtation, according to the �ble regulations of the Departinent of Transportation." Shipper, Per •---F" Agent, Per +Mark w,jtt W to designate Hazardous Material as defined in Tla_ of Federal Regulations. r For further details on TRANSPORTING ? HAZARDOUS MATERIALS see FederalVRKS f FORM No.3841 '�- Regulations 49 CFR, Part 172. - printed in the US.A.