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This Shiin Order -USEDelegiblyDIleain,inlnKnaelblBhench,orin PP Carbon,and retained by the agent shipper No.L�r�� —th �// ! fC[I27�/Cf /PC4e_:1f/- Carrier No. Paget of / �� ✓'� �� 9 f (Name of carrier) (SCAC) Date On Collect an Distant'shiplmrds.the lettsra'Ci.9 appearbelee meglee'e Torre or as wardw Ppvked M Item 43e Sect. FROM: / TO: Shippa �. R�.N r Consignee / ` lA—r '',,''////LL , n Street 1 -- l i�te A Street `Y�"77 V ///r/f f�GI /2)a t/ City __Ll h State /l. Zip Code- �'��,� city State C� ZIP Code /r24 hr.Emergency Contact Tel.No. Vehicle Route Number BASIC DESCRIPTION TOTAL QUANTITY WEIGHT CHARGES NO.of Units Proper Shipping Name,Hazard Class ON or NA Number,Proper;Shipping (Weight hipping Name, (Subject to RATE (For Cartier B Container Type HM UN or NA Number,Packing Group or Hazard Class.Racking Group Gallons,etc.) Corrscliorl) Use Only) 4et Ic un /b r)z o I 4W,4-st " / " c -d iv( PLACARDS TENDERED: YES 1-1 NO D REMIT We—(1)where Me rate is comment en value,shi°cers are oneun.m side I thereby declare that Me comenb orM C.O.D.TO: mm speeauy .no,the agreed or declarred sabre product 'T at Me product m Poll he tairselement are fully and a uremly ADDRESS agrree or declared v real of Me bream,is hereby spasticallystnmd by b¢shipper to dewnsed aboyes by Me proper bcarbide, C.O.D.FEE: beret exceeding per_ name and are chandred. packages, PREPAID ❑ 121 ymere the app'icaae tang powerses scat a emanon of Meadero theory aleeot marked and abdteayaoarded,and are D Amt: $ COLLECT❑ $ ,erase or a yaws declaration by me shipper and Me shipper ems nm release In all respects in proper Earduim for the comer's labtiry ba decom a yeaue Me onal Iw sty shin be Pial As tlq seem transport according to applicable .,sugdA m Smm'I d Nn—does x Me greare is he m etllwred he Ms TOTAL p vAed by such p sae Mile It 1]2. 'ntemaronal and ordered p methal -fdlmrg nmyrse m mignon Me conYenor erten..go Me CHARGES $ dal Co momdes reasoning special o did re or attention in randrre or coming reguafors. rn�vder.n.0 ooe ei' t Mia seemed etMm must be as reacted and packaged a t is trompor ses—See Section 21e)d tipage rs.all our.Indiarae... rye °sy""`"t w FREIGHT CHARGES Imre 360.Bills of Leding,Freight Bills and Statements of Chases end Semon Ila)d FFEIGIn FUlero. Grenw�a merges the Comma Rama and Conditions fa a list of such articles. Signature tallremad�eVM e�n.—m d daricked ❑ dim FECOVEo,wbiea to me dasdfradwrs am,Toole n eMd w IM aab d melesue o1 Mi.eiu of taemg, ,r- tlnahn vq u m eatli pant,Lary time interested in ar a any uid pr.gM.Madevery wMw robe .o properly mscndee above in apparent gal,Dar,exmtt as mad(mtmn6 am,condition of ren pendant mayeader Mal be whgct m an Me bin d laeng tams em,.candsona in Me grocers,das- ams of packages removal,rodded,rens ismi ate.semi a.indwaad above whim win ranter arrested m Me date of shipment. eine v od came,being understood Mmuglwr Ma mno-xt as meaning any parson or concentrate in Shipmr hereby sawas Mal he is familiar dM ax Me,ding mints am catdersons m Me msseuan of M.pmmm once,he mnbael agrees he-1 1.ns usual plata d dereery at sad dasn- scomen m dawificatee ane me sail teams and conditions are hmarry agreed to by Me shipmr and alM,it on.arouse,oMervdse m delete to anomer oomer on Me more 10 said desdmuonIt is made. accept for himself and his assigns. . ly agreed ps Ia each caner at au a any d,said pngedy aver all or any mnlon of sad mute to mea. SHIPPER )IlkiiitZ 17W /_'.A ff - CARRIER f.CP /��/j PER GPER Q // CO p2 DATE (b Permanentt- ice address of shipper. ISI STYLEF380d 02003 tABELMASTER•(800)S21-5808 www.labelimeager.com