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is an acknowledgment that a Bill of Lading has been issued and is not Original Shipper No. This Memorandum Bill of Lading,nor a co uplicate,covering the property named herein,and is PP intended solely for filifqwecord. y Djg Page ofmm Carrier No. (Name of carrier) (SCAC) Date �!�_�� O n Delivery shipments,the letters"COD°must appear before consignee's name or as otherwise provided in hem 430,Sec.1. FROM: �/ 0 Shipper t A* f Consignee V .4 -7 Street"Lk Be !!r_"f .d�',r7t cx ' Street 9310 S-73(' W. �� '"�C��n1 City S)ZkMv1J. State eco zip Code ifs'"', City �,t, State , Zip Code 24 hr.Emergency Contact Tel.No. lb2`7a'aa_76�2 Vehicle Route Number BASIC DESCRIPTION TOTAL QUANTITY WEIGHT CHARGES No.of Units LIS11 Proper Shipping Name,Hazard Class or UN or NA Number,Proper Shipping Name, (Weight, Volume, (Subject to RATE (For Carrier &Container Type fl m UN or NA Number,Packing Group Hazard Class,Packing Group Gallons,etc.) Correction) Use Only) Al uAlk I e. PLACARDS TENDERED: YES o NO =1 REMIT SW) TO: Where the rate is dependent on value,shippers are required to state I hereby declare that the contents of this ADDRESS in writing the agreed or declared value of the property,as follows:'rhe consignment are fully and accurately agre r dC.O.D. declared value of the property is he specifically stated by the shipper to described above by the proper shipping C.O.D.FEE: be not exceeding per name end are classified, packaged, COD Amt: $ PREPAID ❑ (2)Where the applicable tariff provisions specify a limitation of the carrier's liability absent marked and labelled/placarded,and are COLLECT ❑ $ a release or a value declaration by the shipper and the shipper does not release in all respects in proper condition for the carrier's liability or declare a value,the carrier's liability shall be limited to the extent transport according to applicable Subject to Section 7 of the conditions,If this shipment is to be delivered to the TOTAL provided b such provisions.See NMFC Item 172. 9 consi nee without recourse on the consignor,the consignor shall sign the international and national overnmental 8 CHARGES $ P Y P following statement: (3)Commodities requiring special or additional care or attention in handling or stowing regulations. The carriershall not make delivery of this shipment without payment of FREIGHT CHARGES must be so marked and packaged as to ensure safe transportation.See Section 2(e)of freight and all other lawful charges. FREIGHT PREPAID Check box X charges item 360,Bills of Lading,Freight Bills and Statements of Charges and Section 1(a)of except when box at —to be the Contract Terms and Conditions for a list of such articles. Signature (Sig-tun,of consignor) riht is checked ❑ _Ilcl RECEIVED,subject to the classifications and tariffs in effect on the date of the issue of this Bill of Lading, tinatton and as to each parry at any time interested in all or any said property,that every service to be the property described above in apparent good order,except as noted(contents and condition of win- p.d rmed hereunder shall be subject to all the bill of lading terms and conditions in the governing clan- . tents of packages unknown),marked,consigned,and destined as Indicated above which said carrier sifcation on the date of shipment. (the word carrier being understood throughout this contract as meaning any person or corporation in Shipper hereby certifies that he is familiar with all the lading terms and conditions in the possession of the property under the contract)agrees to carry to Its usual place of delivery at said desti- governing classification and the said terms and conditions are hereby agreed to by the shipper and nation,if on its route,otherwise to deliver to another carder on the route to said destination.It Is mutu- accepted for himself and his assigns. ally agreed as to each carrier of all or any of,said property over all or any portion of said route to des- i SHIPPER (� CARRIER l PER , r: DATE i Permanent post-office address of shipper. ®pPo + STY'E 4 F36 ©2003 LABELMASTER®(800)621-5808 www.labelmasteccom w GSG arw sov INICIrrtc. •