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NO <br /> r CARBONLESS CARBON BILL OF LADING <br /> fiops <br /> If a * 0 F� 5641 �" REQUIRED%d TRIPLICATE <br /> ERNATE STRAIGHT BILL OF LADING-SHORT FORM—ORIGINAL—NOT NEGOTIABLE Shipper No. <br /> ,Jame of Carrier: Carrier'sN -)be to <br /> /� 2D2 <br /> TO Consi ee: FROM Shipper: <br /> /,X1 ,m77Dzy 00. <br /> Streets/ � � <br /> Destination Zip Code Emergency Response Phone No. <br /> Route: Vehicle No. <br /> Nn&,,g,nny HxM Kind of Pnekage;Llescl 1pLlun of Articles Special Marks tnld.Exoepnons We,)ht(Sol,,ru Curr.). RALE ✓ CHARGES <br /> 23 <br /> REMIT , CO.FEC <br /> .D <br /> CHN ('ES.APREPAID n 6 <br /> AAe ? 4 COLLECT <br /> y <br /> EJ <br /> °If We shipment moves hatween NOTE: Whore the rate is dependent on value, Subject[o Section 7 of conditions, If this shipment <br /> two parts by a carcier by water. the shippers are required W state specifically in writing is W be delivered W the consignee without recourse FREIGHT CHARGES <br /> law requires that the bill of lading the agreed or declared value of the property. on the consignor, the consfignor shall sign the <br /> shall state whether it is "carriers The agreed or declared value of the property is following statement: Check Appropriate Box: <br /> or shipper's weight'. hereby specifically, stated by the shipper to be not The carrier shall not make delivery of this shipment <br /> exceeding without payment of freight and all other charges. <br /> $ per. ❑ Freight prepaid El Collect <br /> (Signature of Consignor) <br /> RECENEO, sub'ect Lo the classifications and lawfully fled tariffs in effect on the tlate of the issue of receipt by the carrier of the property described in the Original Bill of Lading, the <br /> property descr�ed above in apparent good order,except as noted[contents and condition of contents of packages unknownJ, marked, consigned, end destined as indicated above.which <br /> 12 <br /> 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 W ifs <br /> usual place of derivery at said destination, if on its r6uW, otherwise to deliver Wan other carrier on the route W said destination. It is muWally agreed as to each carrier of ail or any of, <br /> said property over all or any porton of saitl route W destination and as W each party at an time interested in all or any of said property, that every service to ba performed hereunder <br /> shell be sublect W all the Wrens and conditions of the Uniform Domestic Straight Bill of LadYng set forth(1]in Uniform Freight ClessrficaGans m effect on tie date hereof. if this is a rail <br /> or.a raiLwater shipment,or hIs)in the applicable motor carrier classification or tariff if this ie a motor carrier shipment. <br /> Shipper hereby certifies thaC he is familiar won all the terms end condiucns of the said bill of lading, set forth in the classification or tariff which governs the transportation of this <br /> shipral end the said Wrens and conditions are hereby agreed to by the shipper and accepted for himself and his assigns <br /> "This is to certify that the above named materials are properly classired described, packaged marked end labeled, and are in proper condition for transportation, according to the <br /> applicable regulations of the Department of Transportation. <br /> Shipper, Per Agent, Per <br /> Permanent post office address of shipper +Mark with"X"to designate Hazardous Material as defined in Title 49 of Federal Regulations. <br /> For further details on TRANSPORTING <br /> HAZARDOUS MATERIALS see Federal <br /> .S _ I <br /> . FORM No.3841 , Regulations 49 CFR, Part 172. <br /> PrinWd in the U.S.A. <br /> PLEASE PAY FROM INVOICE'*NCS STATFMENT WILL BE SENT <br /> Total s <br />