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ALTERNATE STRf` 'T BILL OF LADING - SHORT FORM <br />Original - Not Negotiable <br />(Name of Carrier) <br />Shipper No <br />Carrier No. <br />Date ---L- ll 7 - dS <br />TO: <br />ConsigneeShipper <br />Street <br />FROM: <br />Street 13HY47 Iv <br />Destination Zip Code Rt{S- <br />Origin Zip Code <br />Route: <br />Vehicle I EMERGENCY RESPONSE PHONE NO <br />Number I ��� ,%- 13R4P <br />No. <br />Shipping <br />units... <br />+ <br />Fill <br />Kin of Packaging, Description of Articles, <br />S ,gglak Marks and Ecce tions <br />weight <br />�sunject to <br />o lection) <br />Rate <br />CHARGES <br />(f r Carrier use only) <br />._;Q o .. <br />i <br />REMIT <br />_ � :�-.. <br />C.O.D. To: PREPAID <br />ADDRESS - Arnt' S - COLLECT C 5 <br />.n the shipment moves betvwen tsw ports by a carrier by ymtor, deTE-tlhm thorebfadperdentv,vM. m7>pe�xerwqu,adn Sugect tt,F cimn 7.1 -,diems. a ra. sl,M.Aa to be del~ TdrAL <br />n <br />m to e consignee raon threcoese on the xrl. !o:. the aapw <br />me opeMm <br />the L,v requires that the bill of lacing chat state whether h is aulespanra��N "`'airY'g r1e ag.eeo or dere ed w,e a w <br />The agreed or Mde,ed vWm d Itis racMny is herby Shall sign ORWoimgSWO-1 CHARGES <br />-career's a shipper's weight'. "if mr shed sy aw WPM t. be ­1ettevding The caner shaft not make rig" of tune st�mwt v 11wt <br />oeT_ M d fico: rind all omtt IMYkd Charges <br />I Shippers imprint in lieu of stamp; rapt a part of bill of lading FREIGHT CHARGES <br />approved by the Interstate Commerce Commission. Check Appropriate Box: <br />s I:r iSgrwua d Coeyno•) ❑ Freight prepaid LJ collect <br />RECEIVED, subject to the classifications -acid le <br />property described above in apparent good order <br />said carrier (the word carrier being understood 1 <br />ususal place of delivery at said destination, I on <br />said property over all or any portion of said rout <br />shall be subject to all the terms and conditions <br />or a rail -water shipment, or (2 in in the applicable mo <br />Shipper hereby certifies tfnat he is famillar wit <br />shi�+menl, and the said terms and conditions are he <br />This is to certify that the above named mate <br />applicable regulations of the Department of Transpc <br />SHIPPER 49T*� �j: <br />PER <br />Permarcnj Dost office address of 811iDDer <br />my filed tariffs in effect on 111e date of the issue of receipt by the carrier of the )r erry described in the Original Bill of Lading, [he <br />xcept as noted (contents and condition o7 contents of packages unkrrotm), marke�, consigned, and destined as indicated above, whiN1 <br />wgbout [his contract as meaning any person or corporation in possession of the property under the cordract) agrees to carry to its <br />mine, otherwise to deliver to another earner on the route to said destination. it is mutually agreod as to each carrier of all or any of, <br />o destination and as to each party at any time interested in all or any of said property, that every service to be performed hereunder <br />the Uniform Domestic Straigqht Rill of Lading sal forth (1) in uniform Freight Classifications in effect on the date hereof, if this is a rail <br />carrier classification or tariff ff this is a motor carrier shipment. <br />all the terms and conditions of the said bill of ladingg set forth in the classification or tariff which governs the transportation of this <br />,)y agreed to by the shipper and accepted for himself and his assigns. <br />Is are properly classified. described, packaged, marker] and labeled, and are in proper condition for transportation, according to the <br />ii ar <br />CARRIER <br />PER C44jriiiis <br />DATE <br />+ MARK WITH 'W2 TO DFSICNATE HAZARDOUS MATERIAL AS DEFINED IN TITLE 49 OF FEDERAL REGULA•110 <br />Fur further details on SHIPPING HAZARDOUS <br />MATERIALS see Federal Regulations 49 CFR, j <br />