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- -••--- ..� ..� u+vsrw - �nvKl CORM - MEMORANDUM COPY
<br />Name q{ Carrier: p Carriers No. LDate Shipper No.
<br />0/3 7 -74t_ -L,
<br />TO Consignee: FROM Shipper! A it ►A A 4c TL ( L,
<br />Street Lg ytt L I
<br />n t f 53 8Tfg
<br />De °n Zip Code 3 1 J c- K T*C•.1 _ "�
<br />Loi t ("'I, ,q Ton c =- 7+ ci �5(�l �� `C z Emergenty Response Phone
<br />Raole 4, , `i6 / , - 2 L
<br />G) 77 l Vehicle No.
<br />No. Shipp . �.,� (p ✓v
<br />llnihpr� F1Af Kd d Podeoge, Description d Amides, Special Marks and Eeceptiores -Weght (Sub. b Carr.1 RATE
<br />✓ 6sAR<SEf
<br />7r; l�cfn i✓j5 f i4nc �ilc Z. �n lista t"A /i -(o
<br />REMIT
<br />C.O.D. TO: C.O.D.---
<br />ADDRESS AMT PREPAID ❑ PRfPALD
<br />COLLECT ❑ i COLLECT S
<br />If IF neer mora beetwaen two parts by NOTE: Where this rak is dspendmt on wlvq Jii n an Su act b
<br />a o w,roc the I,w requiem AnI Are required ro atom Mrd I"W Sedinp 7 of conditions, if Chit shipment is b be ddir- —
<br />bill, hollsmkwhwha,itis'ea"ices vduenithe o lyinwifigrheapeedardeclomt it, bhemneipnoewithong taterrie hamrnipno., hams. FREIGHF CHARGES
<br />o. alit,. . wei hr Pr peM' signor shall sign slier fallowing saacment: p���
<br />9 The aggreed or declared value d the grapey o hereby The carrier doll not mole deliveuy of Acis shipment without goy- Chick Appropriate UIJh;
<br />speallwlVy stated by the shipper tial'
<br />be not eicading mint al Iraigbr and all other charge.
<br />O Freight Prepaid U Called
<br />AKENED su - to rhe dos..hmtians and I,w{ully pled tonfls .n efbct on the dam d the iswe of r..ai ISity�awra [a,.ie,ol
<br />eecept m rwkd (mmm�n and mndirian of mntwin at package unLnawn mo, Pt 61' the earrim of the proprtr dewibed in the Qig I Bil d lading the d ppo good order
<br />I. kd, consigned, and d-h—ol w lediwIed oP hr bd ,cove Ino era
<br />son or corporation in passnsiw of the ro der the creno, Lsove, which said carrier lAw word --hs, being undeneaad rhmuphout Aria mnkod ea meon�Ig
<br />P pars' 1 aprons m curry b sa wool plata of delivery m sold dutirwriws, if an in room, orherw, to b deliver m orother corer m At muk ro said derinoFon Lir muta-
<br />ly agreed as b eod comic. of all m any d, said property wet all or mry gonion of said rook m rlestinotion and oa to cad pony nI any time inkresrd in all ar any of said props that every service b be paAomed hemun-
<br />dr shall 6e subjea ro all Ate kmns and mndlnons d Tho Un�lorm Domestic SnoigM Bill of lading ses torch (I I in Uniiarm Freiphr Cloaifiwlians in ellen car the dok hereat, i! rhia is a mIl or o milw•atr shi
<br />web mob. carrier donifirnrion al tanff it this is a mobr came shipmrsr. pined, or 1214 rhe appli
<br />h� iPPer herby ceniliq% rho he is familiar villi all Aw terms and ,and L of rhe said bill d lading, set forsh ,n the dossilicarion or tariff whirl, gwems the nonsportanan d this sbiprnrd, and the raid Irma and oaldeiom ore
<br />by aB rued so by d�eshipper and arcapnd for himself and his msiggns.
<br />`Lim is ro certify plot the above nomd makrwb a.a properly cloaihe�sducribod, pndeogd, marked and lobdd, and on in mndrio, far nen
<br />Tr—Pono6o'n..• (\ Proper Q spartotion, acwrdmg b this applicable regulations of the Dwoft-I of
<br />I 1l �L Ibipper, � �dt=gn�
<br />% Agra. PerPe monmt post ,{(ice address ofshipper +Mork X' tHazardous Awgeial as defined in Talo l9 of Federal reguladona.
<br />For (urthar d-1 - an TRANSPORTING
<br />HAZARDOUS MATERIALS see federal
<br />Regulations A9 CFR, NO 172
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