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must be f1bly filled In,In Ink,In Indelible Pencil,or In SHIPPER NO. 2� <br /> THIS SHIPPING ORDER "" Carbon,and retained by the Agent <br /> CARRIER NO. <br /> DATE. <br /> -ARRIERSCAC <br /> TO: FROM: <br /> CONSIGNEE °tC �r SHIPPER <br /> —AL. <br /> STREET j <br /> STREET <br /> DESTINATION STATE ZIP ORIGIN STATE zip <br /> ROUTE VEHICLE NUMBER U.S.DOT Hazmat Reg. No. <br /> • <br /> (For lourescent,u-tvlzres,cempacts hid,etc, c7- <br /> Lanj�s ffor VALUE— Universal Kaotle <br /> cJ 7" <br /> + -4'C8.P_ <br /> 'ig <br /> Ktt -194250 cleza <br /> w1rl Of Hazerdous 1'1'ateria.la 1ran.srxirtatio-n. ;!acid 7nr4eney (AWY <br /> V <br /> 11 id Jd <br /> -3 Axeuxt;ifv�- AFRC As egist."nlat <br /> " �"PIAC �,0 <br /> C73 <br /> 3 <br /> vi <br /> Subject to Section 7 of conditions,R this <br /> lemit COD to: shipment Is to be delivered to the consignee COD FEE: <br /> without recourse on theIfinor,the consigror C ODAMT: <br /> statement: <br /> kddress: shelf sign the following con' Prepaid El <br /> The carrier shall not make delivery of this $ <br /> shipm rd without payment of freight and all offer <br /> -ity,- echarifes. <br /> State: Zip: lawful — Collect ❑$ <br /> IOTE:Where the rate is dependent on value,shippers are required to state specifically in writing the TOTAL CHARGES: FREIGHT CHARM—S. <br /> ,greed or declared value of the Property.The agreed or declared value of the property is hereby <br /> pacifically stated by the shipper to be not exceeding$ Per I (Signature ofconsignor) $ El Prepaid —1 Collect <br /> t_CFJVED,sul�ect to individually determined rates or contracts that have been agreed upon fnwriUng between <br /> and shipper,If applicable,otherwise to the rates,classifications and rules tltat have been estabgshed by the carrier and are avagabl <br /> ­ �­ bthe�crrler�a �� <br /> the Sit�per,on request;and all applicable side and federal regulations;dreProperty described above,In apparent good order,except as noted(eontenis and cendttion of ewntents of paidcages unknown),marked,corudgned,and destined as indicate <br /> �iwhich saki wrt,parry(the word companybeing understood throughout this cnnbact as meaning anY parse,or oorporetion in possession of the properly under dte contact)agrees tiD tarty to degvery d saki destination,tt on ds.route,or otherwise tto another carrier on the route to said destination.tt is mutually agreed as to each emrier of all or arty of sael Property over ag or any portion of saki route to destination and as to each party at arty tme interested ht aii or any of said Property that ever to be performed hereunder shall be subject to all the conditions not proh(bited by law,whether printed or written,herein centained,indudfng the cwditions on the back hereof,which are hereby agreed to by the shaper and accepted for himsett and hi <br /> Belong. <br /> IOTE-Liability Limitation for loss or damage In this shipment may be applicable.See 49 U.S.C.14706(cXl)(A)and(B). <br /> bis is to certify that the above-named materials are properly classified,described,packaged,marked,and labeled,and <br /> rein proper condition for transportation according to the applicable regulations of the Department of Transportation PER: <br /> ')HIPPER CARRIER: <br /> A <br /> 'ER: PER: <br /> DATE: <br /> Al <br /> IMERGENCY RESPONSE Monitored at all times.the daardous Material is in transportation <br /> 'ELEPHONE NUMBER: including storage incidental to transportation(172.604). <br /> Agent must detach and retain this Shipping Order <br /> and must sign the Original Bill of Lading. <br /> I-BLO-04 12275 <br />