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STRAIGHT BILL OF LADING - SHORT FORM — Original — Not Negotiable <br />'Carrier) <br />SCAC. <br />3ived, subject to the classifications and tariffs in elfiect on the date of this Bill of Lading: <br />Shipper's No. <br />I <br />Carrier's No. U e 02 -- o 43 0 <br />at , date tic " ,3 c 2 from <br />the property described below, in apparent good ord r, except as noted (contents end condition of contents of packages unknown), marked, consigned, and destined as indicated below, which said company <br />(the word company being understood throughout is 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, a on its own road or its own water line, therwise to deliver to another carrier on the route to said destination. It is mutually agreed, as to each camer of all or any of said property over all or any <br />portion of said route to destination, and as to each rty at any time interested in all or any of said property, that every service to be performed hereunder shall be subject r all the conditions not prohibited by <br />law, whether printed or written, herein contained as y g y shipper and accepted for himself and his assigns. <br />( pacified in Appendix B to Part 1035) which are hereby agreed to b the <br />TO: (Mail or street address of consignee or purposes of notification only.) FROM: <br />Consignee 1<,,.+s b LA.,Li 10L0'�'�cas t <_ Shipper �r✓ f c,� PA �_�, (� <br />Street J 3 t •-1 t-1 Street 833 a <br />Destination Aw-1, <br />74 <br />_ zip Origin C-tQ c" C,.\ Zi q sZ c <br />Route: <br />Delivering Carrier Trailer Initial/Number U.S. DOT Hazmat Reg. Number <br />' _ 1_ ` _ k l�74�ti .•� J Wzt- 1,•Y.� 4 =1 Vr'7 6 <br />Remit <br />C.O.D. <br />to: <br />Address: <br />nelgrior <br />P repaid <br />P <br />City: State: <br />Zip: <br />Ndee -r— the rale �� leo PSM by a onier try Baler, tlr Isw regiry Otet the <br />b elate n <br />d Wiq ehtl sWe •tteOnr O Y •rardKe n sh" <br />egedRuft' <br />The eOreed a dedsred va M PMWt f hereby <br />Ore agreed a detlered waYw d IM Prepsry. <br />epea&My eluted A' tlb ettOpsr b be M aac"*,g <br />Per <br />Thi. N b Da'i'ry the, ere b.—27"nu'e — ProP" CL—did, <br />leeebd, and en In Pr W rn dl bn for banwpPrtetlon eo Pg wow <br />WPkaVed, menta uta <br />**d,r.Pens <br />of `°nom) <br />of r.mpon'sb <br />a aw Ospartrnsre <br />PLA�r a YES NO - FURNISHED BY CARRIER <br />SUPPLIED <br />Pr <br />A' DRIVER'S SIGNATURE: <br />• <br />-_-CIAL INSTRUcrInN t. <br />IrlJ <br />3 <br />-____ - i__ _I_. <br />D AMT: <br />Subject to Section T of rxmdhtorns, If this <br />shipment is to be delivered to the consignee <br />without recourse <br />C. 0. D. FEE: <br />on the consignor, the <br />cashell sign the following statement: <br />nelgrior <br />P repaid <br />P <br />The carrier shall not make delivery of this <br />shipment without payment of freight and all <br />Q <br />Collect El$ <br />Charges Advanced <br />FREIGHT CHARGES <br />(signature <br />of `°nom) <br />Pre aid Collect <br />/ y,J <br />PLA�r a YES NO - FURNISHED BY CARRIER <br />SUPPLIED <br />A' DRIVER'S SIGNATURE: <br />PER t.C. *-► rac.'t�•-, C <br />CARRIER: Ts -S I C <br />DATE: �a ✓ J, of PER: DATE: ill ✓3, Q -L <br />S% EMERGENCY RESPONSE ?OO <br />31�3`+TT <br />Pe— poet ;7.addr., shipper TELEPHONE NUMBER: <br />Monitored at all times the Hazardous Materiel is In transportation Including storage irldderdal to Transportation (§772.Bp.{). <br />29 -BLS -C4 (Rev. 6/95) <br />