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1 fi1J IY1_GIYIVriHIVLJVIYI Is an acknowledgement that a bill of lading hoe been Issued and Is not the Original Bill of Lading,nor Shippers NO. a COPY or duplicate,covering the property named herein,and Is Intended solely for tiling or record Carrier's No. CARRIER,11, .,.Sr,� 1 j? SCAC Date 1—'ZJ- TO: _ FROM: nsignee .1 � ��. 1 t r . r . Shipper ��:. 'J�ydfi f',ir %'Sd Street Street Destination - ; ;r Zip Origin !;�r rye;wt ;;;: Zip Route: Vehicle Number JUS, DOT Hazmat Reg. No. Number of a WEIGHT articles,Shipping Description of exceptions Units HM correction) ...................................- — --- ---._.... ------ ----------- ___.�... __._--- _............. ..... M1 i S. A • r - .,..._.. .. _............ .. _... r _ . ....,. --_..... .... Remit C.O.D. to: rOD C. O. D. FEE: TOTAL CHARGES: Address: V Prepaid❑ City: State: Zip: AMT: $ Collect ❑$ $ 'If the shipment moves between two ports by a carder by water,the law requires that the Subject to Section 7 of conditions if this shipment Is to be delivered to the consignee without FREIGHT CHARGES bill of lading shall stale whether 11 Is"carriers or shippers welghf. recourse on the consignor,fie consignor shall sign She[allowing statement FREIGHT PREPAID IE Note.-where the rate is dependent on value,shippers are required to state specifically In The ranter shall not make delivery of this sh(pment wilhmd payment of freight and all other lawful FRFRwhen CHECK 180X writing the agreed or declared value M the properly. changes. Except The agreed or declared value of the property is hereby specifically staled by the shipper box at right if charges are l0 be not exceeding per (Signature of Cansignar) is checked to be collect RECEIVED,subject to the classifications and tariffs in effect an the date of this BIII of Lading,the property described above In apparent goad order,oxcopt as noted(contents and condition of contents of packages unknown), marked,consigned,and destined as Indicated above,which said company(the word company being understood throughout this contract as meaning any person or corporation In possession of the property under the contract)agrees to carry to ins usual place of delivery at sold destination,If on its own road or its own water line,otherwise to deliver to another carrier on the route to said destination.It Is mutually agreed,as to each Cartier of all or any of said property over all or any portion of said route to destination,and as to each parry at any time Interested In all or any said property,that every service to be performed hereunder shall be subject to all the conditions not prohibited by law,whether printed or written,herein contained(as specified In Appendix B to Pad 1435)which are hereby agreed to by the shipper and accepted for himself end his assigns. This is to certify that the above-named materials are properly classified,described,packaged,marked and labeled and e In proRer con ' on for trans ortat(on according to theapplicable regulations of the Department of Transportation. PER: IPPER: :� 1 CARRIER: - t� � PER: C J-7 Yr LL DATE: - 7 •- ? PER: _FT3Qj t•-3 DATE: }" 231 _Y7 EMERGENCY RESPONSE MONITORED AT ALL TIMES THE HAZARDOUS MATERIALS IS IN TRANSPORTATION, TELEPHONE NUMBER: ( ) INCLUDING STORAGE INCIDENTAL TO TRANSPORTATION(172.604). _ 30-BLS-C3 - - - - - (Rkv.9195)