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STRAIGHT BILL OF LADIN <br />—SHORT FORM —Original —Not Negotiable <br />Shipper's No. <br />arrier) <br />SCAC. Carrier's No. U,o o <br />ived, subject to the classifications and tariffs in eff <br />ct on the date of this Bill of Lading: <br />at <br />t date -�—az from <br />except as noted (contents and condition of contents of packages unknown), marked, consigned, and destined as indicated below, which said company <br />the property described below, in apparent good ord r, <br />(the word company being understood throughout th <br />s contract as meaning any person or corporation in possession of the property under the contract) agrees to carry to its usual place of delivery at said <br />destination, if on its own road or its own water line, <br />therwise to deliver to another carrier on the route to said destination. It is mutually agreed, as to each carrier of all or any of said property over all or any <br />portion of said route to destination, and as to each p <br />rty at any time interested in all or any of said property, that every service to be performed hereunder shall be subject to all the conditions not prohibited by <br />law, whether printed or written, herein contained (as <br />pecified in Appendix B to Part 1035) which are hereby agreed to by the shipper and accepted for himself and his assigns. <br />TO: (Mail or street address of consignee for <br />purposes of notification only.) <br />FROM: <br />Consi nee r d 1 /`o <br />�+ <br />Shipper Un &< c 14 o <br />Street / N g <br />Street 8 3s E- T <br />Destination <br />Zip 922V); <br />q <br />Origin _r10 C_ C',,, Zi <br />Route: <br />Delivering Carrier <br />Trailer Initial/Number <br />umber <br />U.S. DOT Hazmat Reg.Number <br />packages, HM Description special <br />X <br />),7k odisJ, � <br />RaL6 � <br />c C4 <br />A� <br />2I`� <br />/r <br />r <br />S <br />'�f <br />4- <br />------- <br />9' <br />1/()2 <br />-7-ri <br />-3 2 0 <br />0 2 -- <br />Remit C.O.D. to. <br />D AMT: <br />subject to Section 7 of conditions, it this <br />subject <br />shipment Is to be delivered to the consignee <br />v,lthout recourse on the consignor, the <br />. <br />C. 0. D. FEE: <br />Address: <br />consignor shah sign the Wowing statement: <br />Prepaid ❑ <br />City: State <br />Zip: $ <br />The Mier ° me frhall not me delivery of thi <br />shipma without payeight and all <br />other 1 rges. <br />Collect ❑ <br />'e he pigeiatl moves between Iwo ports by s a irner W water, ft wAkes tlat <br />Hda.-whereth.rabmdeoa�.. k., shipper; *.dm.tue <br />de of Ydrq 9W stale whelf.1 it %arrfers a .Irpw witor. <br />:w ng�eag�edadede�d �,d�epmpa�. Charges Advanced <br />FREIGHT CHARGES <br />The speed a declared veAle of he property IS hereby <br />spedleaoy select by the shipper b be not eaeedrg <br />Pa $ <br />21 Prepaid El Collect <br />(sllptaoua of conslg r) <br />TTI. 1. to catty that N..eove.,emea maledale aha prap.dy ota. Ted <br />I.o.lw. W are In proper'.halon z venepor>eeon acc« N to the <br />dl . lbw, pactugw, r,,arkw —o <br />r.qw ti- or me oepatrtient PLACARDS• r YES NO -FURNISHED BY CARRIER <br />o1Tfenfpo sa'REQUIRED <br />Pr <br />I r DRIVER'S SIGNATURE: <br />- t)ECIAL INSTRUCTIONS: <br />TIPPER <br />rJER: - <br />DATE: -7 - Z,"- 0 2 <br />CARRIER: <br />PER: DATE: <br />EMERGEN06RESPONSE <br />TELEPHONE NUMBER: 2— <br />Monitored at all times the Hazardous Material is in transportation Including storage incidental to transportation (§172.604). <br />29 -BLS -C4 (Rev. 6/95 <br />