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This Memorandum Is an acknowledgment that a Bill of Lading has been issued and is not Original ✓-LJ r S.��_ Bill of Lading,nor a ropy or duplicate,covering the property named herein,and is Shipper No. intended solely f 1g or record. Carrier No. Page Of (Name of carrier) (SCAC) Date On Collect on Delivery shipments,the letters"COD"must appear before consignee's name or as otherwise provided in Item 430,Sac.1. FROM: TO: , Shipper Consignee Street Street �!�=��'•rt .� City State Zip Code City an s 1 State f / Zip Code C� f 5%7 24 hr.Emergency Contact Tel.No. Route Vehicle Number BASIC DESCRIPTION TOTAL QUANTITY WEIGHT CHARGES No.of Units HAA or (Weiht, Volume, (Subject RATE Proper Shipping Name,Hazard Class UN or NA Number,Proper Shipping Name, 9 I (For Carrier &Container Typef7�Y� Hazard Class,Packing Group Gallons,etc.) Correction) Use dnly) J �v PLACARDS TENDERED: YES o NO REMIT Note—(1)Where the rate is dependent on value,shippers are required to state I hereby declare that the contents of this C.O.D.TO: specifically in writing the agreed or declared value of the property,a i follows:'The consignment are fully and accurately ADDRESS agreed or declared value of the property is hereby specifically statedby the shipper to described above by the proper shipping - C.O.D.FEE: be not exceeding _ _ per name and are classified, packaged, COD Amt: $ PREPAID ❑ (2)Where the appficable tariff provisions specify a limitation of the carriers liability absent marked and labelled/placarded,and are COLLECT ❑ $ a release or a value declaration by the shipper and the shipper does not release in all respects in proper condition for the carriers liability or declare a value,the carrier's liability shall be limited to the extent transport according to applicable Subject to Section 7 of the conditions,if this shipment is to be delivered to the TOTAL provided by such provisions.See NMFC Item 172. international and national governmentalsignee without recourse on the consignor,the consignor shall sign the CHARGES $ /ollowi (3)Commodities requiring special or additional care or attention in handling or stowing regulations. The statement:carrier shall not make delivery of this shipment without payment of FREIGHT CHARGES must be so marked and packaged as to ensure safe transportation.See Section 2(e)of freight and all other IawIul charges. FREIGHT PREPAID Check box if charges item 360.Bills of Lading,Freight Bills and Statements of Charges and Section 1(a)of FREIexcept GHT aretobe the Contract Terms and Conditions for a list of such articles. Signature (Signature of Consignor) right Is checked ❑ oolleq RECEIVED,subject to the classifications and tariffs in effect an the date of the issue of this Bill of Lading, tination and as to each party at any time interested in all or any said property,that every service to be the property described above in apparent good order,except as noted(contents and condition of con- pertormed hereunder shall be subject to all the bill of lading terms and conditions in the governing clas- tents of packages unknown),marked,consigned,and destined as indicated above which said carrier sificalion on the date of shipment. (the word carrier being understood throughout this contract as meaning any person or corporation in Shipper hereby certifies that he is familiar with all the lading terms and conditions in the possession of the property under the contract)agrees to carry to its usual place of delivery at said cl sti- governing classfficmtion and the said terms and conditions are hereby agreed to by the shipper and nation,if on its route,otherwise to deliver to another carrier on the route to said destination..It is mutu- accepted for himself and his assigns. ally agreed as to each carrier of all or any of,said property over all or any portion of said route to des- SHIPPER fir' CARRIER PER ;/,'�; � PER 1 DATE Permanent post-office address of shipper. _ STYLE F360-3 ®2003 LABELMASTPR®(800).621-5808 www.labelmaster.com on ara,..eo Paye mus xc soves,w ax SOY INK - -