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R HELP IN CHEMICAL EMERGENCIES INVOLVING SPIL K, <br /> R EXPOSURE CALL TOLL-FREE 1-800-424-9000 DAY GHT <br /> STRAIGHT BILL OF LADING <br /> ORIGINAL - NOT NEGOTIABLE j�� `-��� Shipper's No. <br /> Carrier's No. <br /> �� l //5 �h star SCAC Date -�� <br /> (NAME OF CARRIER) <br /> TO: �v1 L,, FROM: /. <br /> Consignee /r/C�, e{�J�/,�/✓ i �ien,si,n., hipper �/Y/! C/` /1� �� Cf3 <br /> Street Street j <br /> is Destination /✓C c �Ct P % � . 7D Ori in^t/e 12P Zip <br /> Vehicle <br /> Route: Number <br /> int of ,.., I. RATE LAI <br /> (IFRAZARDOUSAINTEIRAL&- <br /> 'eve li <br /> [v STS- �rz Ty ,,9n/ <br /> 9-0 Z <br /> S_�/'i'/��i /%'�?/ :zit.✓' <br /> Remit C.O.D. to: C.O.D. FEE: <br /> (� <br /> Prepaid CD <br /> AdState: Zip: COD Amt: $ Collect ❑ $ <br /> NOTE- Where the rate is dependent o value,shippers are fepuned to state specifically in uniting the 'd"^"`^°^"'Mt; °-"'.:.�:.w'""wreored"'"°""'�"" FREIGHT CHARGE! <br /> agreed or declared value of the property.The agreed or declared value of the properly Is henbY The ane. wnwe army aaw we,u.vm ware <br /> specifically stated by me attitude,to ba not eueeding PREPAID COLLECT <br /> $ Per (save—acw.w, ❑ U <br /> RECEIVED,subject to the classification,and tariffs in affect on the data of issue of this Bill of Lading,the P.P.",described above in apparent good order,eacept as noted(content.and condition of u <br /> Contents of packages unknown',marked.consigned,and destined as indicated above which said carrier(the word carrier being understood throughout this contratt as meaning any peraan or corporation <br /> in possession dl the padpeny under tM1e convapq agrees la carry ld its usual place of delivery at said destination.if on ill route,whrunviae to deliver to another carrier on the route to said destination,It <br /> is mutually agreed as to each carrier of all or any of,saw property over all or any demon df said route t0 desunaoon and m to each deny at any time interested in all or any saitl property.that every <br /> service to be performed he...no. shall be subject to all the bill of lading terms and conditions in the governing classification on the date of shipment. <br /> Shipper hereby certifies that he is farm,le with all the bill of lading terms and conditions in the governing classification and the said terms and conditions are hereby agreed to by the shipper and <br /> accepted for himself and his assigns. <br /> 1 and labeled and an!o he ow common maleroda ppp CWM,P w14In aaawKw.°regulations of tN <br /> pmpar condition lo..on: a m ma a <br /> O:penmem of Twnaponalien. •� F.. <br /> '?}t Par <br /> SPECIAL INSTRUCTIONS: - a ❑ YES El YES FURNISHED BY CARRIER <br /> a DRIVERS SIGNATURE: <br /> SHIPPER: CARRIER: <br /> PER: PER: J7tsl�%�-1� <br /> DATE: DATE' - <br /> x <br /> ' "• FORM#8-21LS-C(4 PLY) Rei 10.'86 <br /> •d�' . , t t "e IM <br /> 1 I I <br /> i.TFk",Ly1�y^,yFyt, .S��^.'' a.; - FOR HELP IN CHEMICAL EMERGENCIES INVOLVING SPILL LEAK, 4 -y"•'` <br /> f'.i-5:!:: F R c' TOLL-FREE 1-800-424-0200 OA) OR NIGHT b yA .:J' <br />