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STRAIGHT BILL OF LADING—ORIGINAL—NOT NEGOTIABLE vuRr9721 b 09S Shipper's No. Carrier T I- 1� C.�at 1R�� T /— Cr��CAC Carrier's No. RECEIVED,Subject to individually determined rates or con racts that have been agreed upon in writing between the carder and shipper,it applicable,otherwise to the rates,classifications and rules that have been established by the carrier and are available to the shipper,on request;and all applicable state and federal regulations; at , date W—&y/ from the Property described below,in apparent good order,except as noted(contents and condition of contents of packages unknown),marked,consigned,and destined as indicated below,which said company (the word company being understood throughout this contract as meaning any person or corporation in possession of the properly under the contract)agrees to carry to delivery at said destination,if on its route,or otherwise to deliver to another carrier on the route to said destination.It is mutually agreed as to each carder 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 it all or any of 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,including the conditions on the back hereof,which are hereby agreed to by the shipper and accepted for himself and his assigns. TO: FROM: Consignee Shipper Street0`7 Street ]Z . 5-1 Destination wa0J a Zip G a Oric lin Zi 0 Route v If Delivering Carrier Veh' le Num er U.S. DOT Hazmat Reg.No. 2 NumberWeight . .• • . • Class or HM Descriptionof Articles (subject to of Rate a -_ e _ 11-.19- Doo 1 3 Z suta�rto delve of to.nen=.l i s COD FEE: Remit COD to: ehipment Is to delivered to the consignee ( OD AMT: without recourse on the consignor, the v Address: coni norshallsign the to llowingslatement: Prepaid ❑ TTe came,shall not make delivery d this City: State: Zip: shipment without payment of freight and all ) Collect ❑$ other lawful charges. •P NOTE:Where the rate is dependent on value,shippers are required to state specifically in writing TOTAL CHARGES: FREIGHT CHARGES: the agreed or declared value of the property.The agreed or declared value of the property is dQ� hereby specifically stated by the shipper to be not exceeding $ Per (Signature of Consignor) W ❑Prepaid Collect NOTE:Liability Limitation for loss or damage In this shipment may be applicable.See 49 U.S.C. 147 c 1 A and(B). ,. ❑BY SHIPPER BY CARRIER This is to certify that the above-named materials are property classified,described,packaged,marked and labeled,and are in proper condition for transportation according to the applicable regulations of DRIVER'S the Department of Transportation. Per SIGNATURE: SHIPPER: ZJ Pfl CARRIE : PER: DATE: PER: DATE: EMERGENCY RESPONSE NAME OR CONTRACT NUMBER TELEPHONE NUMBER: OR OTHER UNIQUE IDENTIFIER: 29-BLS-C4 970(Rev.9/10) 51