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ust be regi...,dlled In,in Ink,In Indelible Pencil,or In ✓ THIS SHfPPING ORDER Carbon,and retained by the Agent. SHIPPERNO. r CARRIER NO. c� DATE ARRIER SCAC TO: * ,-�'r� J (40 t<,ca SChot)l 01S FROM: 4Effe 'DONSIGNEE SHIPPER �(i % 7 �Gf �tr�� STREET STREET �f � )ESTINATION ( `) tiro STATE ZIP °� ORIGIN 1-14 WJ4,W_j STATE ZIP IOUTE VEHICLE NUMBER U.S.DOT Hazmat Reg. No. 4umber and Type HIVI Description of Articles Class or of Packages Rate ♦ - -Subject to Section 7 of conditions,If this COD FEE: et11lt COD lO. shipment is to be delivered to the consignee �O D AMT: without recourse on the consignor,the consignor ddress: sharsignthefollowingstatement Prepaid ❑ ♦ The canter shag not make delivery of this & Q` I : Stale: Zip: shipment without payment of freight and all other Collect ❑4+ lawful charges. )TE:Where the rate is dependent on value,shippers an required to state specifically in writing the TOTAL CHARGES FREIGHT CHARGES: reed or declared value of the property.The agreed o declared value of the property is hereby x1fically stated by the shipper to be not exceeding $ Per (signature of consignor) $ ElPrepaid ❑Collect CEIVED,subject to Individually determined rates or contracts that I lava been agreed upon in writing between the carrier and shipper,d applicable,otherwise to the rates,classifications and rules that have been established by the carrier and are available he shipper,on request;and all applicable state and federal regul ions;the Property described above.In apparent good order,except as rated(contents and condition of contents of packages unknown),marked,consigned,and destined as Indicated ae 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 delivery at said desfinaWn,if on Its route,or otherwise to ver to another carrier on the route to said destination.It Is mutuallyagreed 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 parry at any time interested In all or any of said Property that every doe tube performed hereunder shall be subject to all the condition not prohibited by law,whether printed or written,herein contained,Including the conditions on the back hereof,which are hereby agreed to by the shipper and accepted for himself and his I ns. -TE:Liability Limitation for loss or damage in this ship ent may be applicable.See 49 U.S.C.14706(c)(1)(A)and(B). lis is to certify that the above-named mater i Is are properly classified,described,packaged,marked,and labeled,and in proper condition for transportation acco ing to the applicable regulations of the Department of Transportation PER: ilPPER: r•' *'- CARRIER: ' ✓ °' PER: :R: .� DATE: AERGENCY RESPONSE Monitored at all times the Hazar us Material is in transportation :LEPHONE NUMBER: ( ) including storage incidental to transportation(172.604). ^ (`Agent must detach and retain this-Shipping Order [�/�) and must sign the Odgkid B111 of Lading. -BLC-03 12267