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Is an aclerowk dgemeet theta bill of lading has been iaaued and Is not the Odglnaf8til of Lading,nor Shipper's No. a Copy or duplicate,covering the property named herein,and is intended sotety for filing or record. . Carrier's No. CARRIER: WA-517,1t ` ;��l� f;. !Y1 �. it1 � SCAC Date TO: ✓ _ FROM:�y r`.:>..^fonsignee �O�CC7 ��] o t Shipper f r" Street � f h} '`_ Sheet1,3 � F Destination. Zip r `ems.' Origin P ly y Zip i Route: �ejLlicle Number U.S.DOT Hazmat Reg. No. Num.- a CLASS .- ..ing Description 'J. units H M RATE CLASS RATE a' JI 71 i r } s r I � •�^ V Remit C.O.D. to: .COD D. FEE: TOTAL CHARGES: Address: V Prepaid❑ City: State: Zip: AMT: $ Collect ❑$ $ 'll the shipment moves between two parts by a carder by water,the law requires that the- c Subject to Section 7 of car4tions If this shipment Is to be delWemd to the consignee without bill of lading shall state whether It Is'carder's or shipper's weight". recourse on the consignor,the consignor shall sign the following statement FREIGHT CHARGES Note.-where the rale Is dependent on value,shippers are required to stale specifically in The carder shell not make delivery of this shipment without payment at height and all other lawful FREIGHT PREPAID writing the agreed or declared value of the property.--. charges. Except when CHECK BOX The agreed or declared value of the property Is hereby specifically staled by the shipper two at right d charges are to be not exceeding per (Signature of consignor) Is checked 11 to be colied RECEIVED,subject to the Gaselflcatlons and tariffs In effect on the date of this Bill of Uding,the property described above In apparent good order,except as noted(contents and condition of contents ofpp'�gas unknown), marked,consigned,and destined as Indicated above,which said company(the word company being understood throughout this contract as meaning arty person or corporetlon In possession of Ilt-pl gas under the contract)agrees to carry to Its usual place of delivery at said destination,If on its own road or its own water line,otherwlse to deliver to another carrier on the route to sold destination.II Is mubrally agreed,as to each carrier of all or any of said property over all or any portion of said route to destination,and,as to each party at any time Interested In all or any said property,that every services to be performed hereunder shall be subject to all the conditions not prohibited by law,whether printed or written,herein contained(ae specified in Appendix B to Part 1M)which are hereby agreed to by the.shipper and accepted for himself and hie assigns. This is to certify that the above-named materials are property classified,described,packaged,marked and labeled and ire in proper condition for transportation according to the appilcable regulations of the Department of Transportation. PER: IPPEn. <` CARRIER: ' PER: DATE:.; PE : tJ DATE: r 1 EMERGENCY RESPONSEMONITORED AT ALL TIMES THE HAZARDOUS MATERIALS IS IN TRANSPORTATION, TELEPHONE NUMBER: ( J y INCLUDING STORAGE INCIDENTAL TO TRANSPORTATION(172.604). 30-BLS-05 - * - - - - (REV _ - .9tg5)