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if MAIUM i GILL vl" LAUINU - SHURT FORM - Original - Not Negotiable <br />Sf iipper's No. <br />t(arrier) -,Ms l,,,,,, SCAC. Carrier's No. V`'P 0"i - 0"3 C <br />'Ned, subject to the classifications and tariffs in effect on the date of this Bill of Lading: <br />c1t IL I I gate % o from <br />the property described below, in apparent good ord@r, except as noted (contents and condition of contents of packages unknown), marked, consigned, and destined as indicated below, which said company <br />(the word company being understood throughout this 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, 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 party 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 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 or purposes of notification only.) <br />Consignee - 4 I r <br />FROM: Q <br />Shipper �k_ 1C,,_0 <br />Street <br />Street Y3 3 rz- . <br />Destination <br />Zip <br />Origin S-4'Zc e +qtr- Cad . Zi <br />Route: <br />Delivering Carrier <br />Trailer Initial/Number <br />U.S. DOT Hazmat Reg. Number <br />No. of <br />ackages"'HM <br />Description of articles, special <br />marks, and exceptions <br />Hazard <br />Class <br />I.D. <br />[Number <br />NLP <br />Packing <br />G° <br />Ye <br />7 <br />Remit C.O.D. to: <br />Add,,1 ress. <br />City: State: <br />Subject toSection 7 of cora" C. 0. De FEE: <br />COD AMT: w"'e'"an! is to delivered to the <br />without recoursree on the consignor, the <br />consign« shell sign the 'ng statement Prepaid ❑ <br />Zip: $ The t carrier °"° °°I Collect ❑ $ <br />shipment with a o t end ell <br />bd a lair" dW eWe ~.1 M'mrrieh « $*W. _.gy. other lawful <br />In WftV"�eed«dad. ek.cflheprnperly. Charges Advanced FREIGHT CHARGES <br />°" ate) El Preload El Collect <br />p•«res•d, manor .rw <br />1eo'�ieom «eo ann-- _ ' _aYES NO -FURNISHED BY CARRIER <br />tDRNER'S SIGNATURE: <br />'M srs eh9mem mores between ho Dom• by • nmar M eetx, tlu Iew repirea tlut <br />•-.hereneatesde0eden1mve1e,N4D•eenwysameme,pe W <br />reed <br />V-kthe " or deed dawlWe d the PiWery 4 hereby <br />* iitsl.ebyVis W WbbeMewm&q <br />This is to � ty stat ab -1 m <br />e ab -1 .re prawns ct—ifi d, <br />a TM•a«, am p`� aori low r°` °•a•por don •c`°'d V w ow <br />"--(,'IAL INSTRUCTION <br />PE 47r-4 c <br />.••rCZ7 <br />CARRIE <br />DATE:!yO� �. C'L PER:NO.� 3. C L <br />DATE: <br />EMERGENCY RESPONSE e00 '3 ►3 3 4rT <br />TELEPHONE NUMBER: <br />Monitored at all times the Hazardous Material Is In transportation Inclu?xp storage ktctdentat to traruportatbn (6172.6o4). <br />Pemtanem post office address of shipper <br />29 -BLS -C4 (Rev. 6/95) <br />