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,,✓STRAIGHT BILL OF LADING Shipper No. ORIGINAL—NOT NEGOTIABLE Carrier No. of a It l::'l_ 1 R S-H Page Date (Name of carrier) (SCAC) On Collect on Delivery shipments,rite leners'COD-must appear before consignee's name or as otherwise provided In Ilem 430,Sec.1. FROM: 7—Eleven 119976 Shipper Consignee i T01af. elphia RecvC inq Mins rt� 5959 MAIN rr99r� cr —ys Street �1�� `i. �Yf�tl P,f �a Street -12000 Philadelphia 33rpe� olcy MANT E CA Statet�:..� Zip Code 95336 nPIh. 9*1715 Cl all4� C�t[i� State, �� Zip Code -� s�_f:'� city p 24 hr.Emergency Contact Tel.No. `= `I -`4 �' ll- Vehicle Route Number No.of Units BASIC DESCRIPTION TOTAL QUANTITY WEIGHT CHARGES Proper Shipping Name,Hazard Class UN or NA Number,Proper Shipping Name, (Weight, Volume, (Subject to RATE (For Carrier &Container Type UN or NA Number,Packing Group or Hazard Class,Packing Group Gallons,etc.) Correction) Use Only) Non Hazcardlous Concrete E l : 2419 9cu* PLACARDS TENDERED: YES m NO REMIT C.O.D.TO: Note—(1)Where the rate Is dependent on value,shippers are required to state I hereby declare that the contents of this ADDRESS speagcagy In writing the agreed or declared value of the property,as follows:'The consignment are fully and accurately .greed ar declared value of Ne property is hereby specifically staled by 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 Me applicable tariff provisions specfly a limitation of the callers liability absent marked and Iabehod/plecarded,and are COLLECT❑ $ a release or a value declaration by the shipper and the shipper does nbt release In all respects In proper condition for the camera lability or declare a value,the carders liability shall be limited to the extent transport according to applicable Subject to Sectlon 7 of the conditions,If this sMpment Is to be delivered to the TOTAL provided by such provisions.See NMFC Item 172, International and national governmental consiggnee without recourse on the consignor,the consignor shall sign the CHARGES 3 Commodities requiring Special or additional care or attention In handlln or stowin lollowing statement: () 9u 9 P g 9 regulations. Tho cantor Shell not make delivery of this shipment without payment of FREIGHT CHARGES must be so marked and packaged as to ensure safe transportation.Be.Section 2(e)of freight and an other lawful charges. Item 360,Bills of Lading,Freight Bills and Statements of Charges and Section 1(a)of FREIGHTPREPAID Check box irMe. the Contract Toms and Conditions for a list of such articles. Signature right when box at arewk be 9 (Sl.nalure of caugnm) right le Checked ❑ 6ect RECEIVED,subject to the classifications and tangs In affect on the dale of the laws of this BRI of Lading, lination and as to each party at any lime interested in eel,or any said property,that every service to be the property described above In apparent good order,oxcapl as noted(contents and condition of con- pedonned hemunder shag be subject to all the bill of lading terms and oonditions in the governing das- lents of packages unknown),marked,consigned,and doetlnod as Indicated above which said carder sllkat1.on the date of shipment. (the word carder being understood throughout this contract as meaning any person or corporation in Shipper hereby canines 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 dead- governing classification and the said terms and conditions are hereby agreed to by the shipper and nation,if on Its mule,otherwise to deliver to another carder on the mule to said desllnetion.It Is mulu- accepted for himself and his assigns. any agreed as to each carder of all or any of,said property over all or any portion of said route to des- SHIPPER CARRIER BELSHIRE PER PER DATE ,� LJ pC . Permanent post-office address of shipper. ®�q�,�w;,��^� •�er�Nk- STYLE CF365-4 02003 LABELMASTFR® (800)621-5808 www.labelmaster.com