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THIS SHIPPING ORDER must be legnuiy filled In,in Ink,in Indelible Pencil,or in SHIPPER NO. _7 7
<br /> Carbon,and retained by the Agent.
<br /> CARRIER NO.
<br /> DATE
<br /> -ARRIE R 3 SCAC
<br /> TO: FROM:
<br /> CONSIGNEE SHIPPER
<br /> STREETSTREET rillt _Y!1/.
<br /> ji
<br /> DESTINATION -1�4 -,4 STATE ZIP ORIGIN ,f'``
<br /> it
<br /> _6 STATE!_. ZIP
<br /> ROUTE VEHICLE NUMBER U.S.DOT Hazmat Reg. No.
<br /> �Number and Type Total Quantity Weight Class o-1
<br /> of Packages H.M Description of Articles (mass,volumej (subject to Rate
<br /> oractivity) correction)
<br /> (For Im r-sf iouresopnt.u—tvbea,eAmpaets,hid,e-te.
<br /> W9_-----N0 VALUE-, Universa.- Wa
<br /> x Used/Sient T.,mps f-,or C,
<br /> I
<br /> I-KYr NIX--Rev 'I tFC TASS 56
<br /> ,ale-ted W .4 194250-00
<br /> X ts 5r� 1`1113N U a e d/Srg ri t Ba I I a-,(t f or
<br /> ,.-n Case Of Hazardoua ',Iatkr.t&18 Trallsportatitan Eiu-rgericy SUr
<br /> .end s tx a,i
<br /> III YTRAC (4 f.-800--535-50,3 d I lent Uv AFRC A eg�ts Y, t
<br /> J
<br /> Subi t to Sectiort 7 of conditio if
<br /> consignee COD FEE:
<br /> nor
<br /> without recourse on the wnskjncir,the consignor CODAMT:
<br /> lemit COD to: shipment Z to be delivered to the
<br /> kddress: shall sig'the following statement:
<br /> The carrier shall not make delivery of this Prepaid
<br /> "ity: S ❑
<br /> tate: Zip: shipment without payment of freight and all other
<br /> lawful charges. Collect $
<br /> IOTE:Where the rate is dependent on value,shippers re required to state specifically in writing the TOTAL CHARGES:
<br /> greed or declared value of the property.The agreed )r declared value of the property is hereby FREIGHT CHKA—GES.
<br /> pacifically stated by the shipper to be not exceeding Per (Signature of Consignor) $ ❑Prepaid 0 Collect
<br /> i;.�not; ,sl
<br /> fh�
<br /> ECE VED,subject to Individually determined n have been agreed upon in writing between the carrier and shipper,it applicable,otherwise to the rates,classifications and rules that have been established by the carrier and are avaiIZI,
<br /> I I t
<br /> the shipper,on request;and all applicable state and federal 1,�,rfheis`ropedy described above,In apparent good order,except as noted(contents and condition of contents of packages unknown),marked,consigned,and destined as indicate
<br /> slow which said company(the word company understood
<br /> contract as meaning any person or corporation in possession of the property under the contract)agrees to may to delivery at said destination,it on Its route,or otherwise tc
<br /> deal
<br /> being
<br /> q
<br /> Aver to another carrier on the route to saidon.It is metuaOly 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 of said Property that ever,
<br /> "vim to be performed hereunder shall be subject to all the condifilris not prohibited by law,whether printed or written,herein contained,including the conditions an the back hereof,which are hereby agreed to by the shipper and accepted for himself and hi.;
<br /> ns.
<br /> OTE:Liability Limitation for loss or damage In this shmerit may be applicable.See 49 U.S.C.14706(c)(11 XA)and(B).
<br /> his is to certify that the above-named mater�als are properly classified,described,packaged,marked,and labeled,and
<br /> re in proper condition f9f;,transportatiog according to the applicable regulations of the Department of Transportation PER:
<br /> ;HIPPER: CARRIER:
<br /> ,ER: PER:
<br /> DATE:
<br /> :MERGENCY RESPONSE Monitored at all times the Hazardous Material is in transportation
<br /> ELEPHONE NUMBER: including storage incidental to transportation (172.604).
<br /> Agent must detach and retain this Shipping Order
<br /> 1-BLC-04 12278 and must sign the Original Bill of Lading.
<br />
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