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THIS SHIPPING ORDER <br /> must be�ipyrrbon d n by Ag®terfcll.orin w ' +s�# 1T."ER NO. <br /> CARRIER N0, <br /> DATE <br /> DARRIER SCAC <br /> TO: neytc FROM: Ire L vijj 7, 41— c„,Al0d, r <br /> CONSIGNEE SHIPPER <br /> STREET STREET &A0 4,4 S 01 <br /> r <br /> DESTINATION � � STATE ZIP ORIGIN ' k` ' �­STAflg 5 ZIP <br /> ROUTE VEHICLE NUMBER U.S.DOT Hazmat Reg.No. <br /> Class o' <br /> !- • • e <br /> now <br /> lya <br /> 4 <br /> ♦ ♦ Subject to section 7 of conditions,If this ('`®® FEE <br /> Remit COD to: shipment into be delivered to the consignee /t p AT. v <br /> without recourse on the consignor,the consignor /"'l'V I <br /> Wdress: shelf sign the following statEmertPrepaid ElThe canter shell not make delivery of this P <br /> , State: Zip: ch without perms of freight and all anal Collect El40TE:Where the rate is dependent on value,shippers are required to state specifically in writing thelawu TOTAL CHARGES• FREIGHT CHARGES <br /> (greed or declared value of the property.The agreed or declared value of the property is hereby <br /> 1pedficalty stated by the shipper to be not exceeding $ I ., Per I (signature of consign $ ❑Prepaid ❑collect <br /> iECEIVED,subject to Indivk uagy determined rates or contracts that have been agreed upon in writbng betvreen the canner and shipper,If applicable,otherwise to the rates,datisWcations and rules that have been established by the carrier and are avalllat <br /> the shipper,on request:-and all applicable state and federal regulations:the Property descrRed above,in apparent good order,except as noted(contents and condition of coments of packages unknown),marked,consigned,and destined as indk;at <br /> bow which said company(the word company being understood throughout this contract as meaning any Person or corporation inpossession d the property under the contract)agrees to carry to delivery said destination:If on its route,or otherwise <br /> IaMar to another carrier on the roma to said destination.it Is mutualy agreed as to each carver of al or any of said Property over all or any portion of said rouro to destination and as to each party at any time Interested in all or airy of said Property that ev, <br /> ervice to be performed hereunder shall be subject to all the conditions not prohibited by law,whether printed or written,herein contained,indud inti the conditions on the back hereof,which are hereby agreed to by the shipper and adapted for himself and I <br /> OM:LiabMty Umttatlon for loss or damage In this shipment may be applicable.See 49 U.S.C.14706(cx1)(A)and(B). <br /> -his is to certify that the above-named materials are properly classified,described,packaged,marked,and labeled,and <br /> ire in proper condition fort nspo accor.ing to the.applicable regulations of the Department of Transportation PER: <br /> 'HIPPO <br /> Ze <br /> CARRIERS <br /> 'ER: PER: <br /> DATE: <br /> EMERGENCY RESPONSE Monitored at all times the Hazardous Material is in transportation <br /> 'ELEPHONE NUMBER: ( including storage incidental to transportation(172.604). <br /> fjg�Agent at annual:sign hOriginal Bill of t.oiand retain this ngng Ord®r <br /> 11-BLC-O4 12278 <br />