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This Memorandum is an acKnowfeagment tnat a tial Ot Lading has been issued and is not Original Vi Bill of Lading,nor a copy or duplicate,covering the property named herein,and is Shipper No. _6490e U- intended solely f ig or record. n ? Carrier No. Page Of (Name of carrier) (SCAC) Date V C On Collect on Delivery shipments,the letters"COD"must appear before consignee's name or as otherwise provided in Item 430,Sec.1. FROM: TO: ' y� Shipper ... ' Consignee /� e A/l . J Street Street �� L•` � { %�.%�� ::,:/ � c'' — City v State Zip Code y ?G7' % n City ,l f ✓: tf State ri Zip Code L/ (1 24 hr.Emergency Contact Tel.No.. Route Vehicle Number BASIC DESCRIPTION TOTAL QUANTITY WEIGHT CHARGES No.of Units L11►A Proper Shipping Name,Hazard.Class UN or NA Number,Proper Shipping Name, g (Subject (For Carrier Il�Y� or (Weight, Volume, orr cti n) RATE &Container Type. � UN or NA Number,Packing Group Hazard Class,Packing Group Gallons,etc.) Correction) Use Only) r',. .. , , rpt e r.c;r d PLACARDS TENDERED: YES I1 NO o 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,as follows.'The consignment are fully and accurately ADDRESS agreed or declared value of the property is hereby specifically stated by the shipper to described above by the proper shipping C.O.D.FEE: benot exceeding per name and are classified, packaged, COD Amt: $ PREPAID ❑ (2)Where the applicable tariff provisions specify a limitation of the carrier's liability absent marked and labelled/placarded,and are a release or a value declaration by the shipper and the shipper does not release in all respects in proper condition for COLLECT El $ 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 governmental consignee without recourse on the consignor,the consignor shall sign the CHARGES $ (3)Commodities requiring special or additional care or attention in handling or stowing regulations. following statement: The wrtler shall of ake 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 lawlul charges. FREIGHT PREPAID Chock box if charges item 360,Bills of Lading,Freight Bills and Statements of Charges and Section 1(a)of except when box at are lobe the Contract Terms and Conditions for a list of such articles. Signature fsgnature of Consigmop right's checked ❑ C041W RECEIVED,subject to the classifications and tariffs in effect on 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- performed 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 canner - sification on the date of shipment. (the word camier being understood throughout this contract as meaning any person or corporation in Shipper hereby certifies that heis familiar withall 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 desti- governing classification 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 CARRIER PER /. rf7 PER DATE o.✓ _-._ Permanent post-office address of.shipper. � EOP STYLE F360-3 ®2003 LABELMASTFA0(800)621-5808 www.labelmaster.com