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i�NNu iy v�iaCr __..............._,, Carbon,and retained by the agent... _ Shipper Carrier No. Page of (Name of carrier) Date (SCAC) On Collect on Delivery shipments,the lettem-coD-must appear before consignee's name oras otherwise provitletl In Item 4JSec Sec.T�' ROM: �/ Consignee�j hipper /f- - Svc 5 Street /a0 ,G'f/ reet �'2��,� 4 State � �iSLpGCity /Sy�'" State, /' Zip CodeZip Code�J3/ hr.Emergency Contact Tel,No. Route Vehicle No.TH BASIC DESCRIPTION Number $ConProper Shipping Name,Hazard Class or UN or NA Number,Proper Shipping Name, TOTAL QUANTITY WEIGHT UN or NA Number,Packing Group Hazard ClassPacking Group (Weight, Volume, CHARGES Gallons,etc.) Correctiono RATE (For Carrier Use Only) — i I I PLACARDS TENDERED: YES tI NO p REMIT Note—(1)Where the rate is dependent on value,shippers are required to state I hereby declare that the contents of this C.O.D.TO: specifically in writing the agreed or declared value of the property,as follows:'The consignment are fully and accurately ADDRESS agreed or declared value of the property Is hereby specifically stated by the shipper to described above by the proper shipping be not exceeding per name and are classified, COD (2)Where the applicable tariff provisions speciry a ifmltation of the carvers liability absent marked entl labelled/placaNeda end are V C.O.D.FEE: a release or a value declaration b the shipper Amt: $ PREPAID ❑ y peer and the shipper does not release In all respects in proper condition for COLLECT ❑ $ the carders liability or declare a value;the camers If shall be limited to the extent transport according to appllCHble Subject to Section 7 of the conditions,If this shipment is to be delivered to the provided by such provisions.See NMFC Item 172. International and national governmental consti nee rntnom recourse on the consignor.the const TOTAL (3)Commodities requiring special or additional care)or attention In handling or stowing regulations. lonovdng statement: consignor shall sign the CHARGES $ must be so marked and packaged as to ensure safeltransportation.Sao Section 2(e)of naighl and e I o}heeflavAulmake delivery of this shipment without a FREIGHT CHARGES Item 360,Bills of Lading,Freight Bills and Statements of Charges and Section 1(a)of payment of the Contract Terms and Conditions for a list of such articles. FREIGHT PREPAID Check box if charges Signature --� except when box at -Is to be f5lgnalura al Cansgnsrj dgM fe checked RECEIVED,subject to the claeslficalions and tariffs in effect on the tlate of the issue of this Bill of Lading, cUIw 9 Performed and re to each party at any time interested in all or any said property,that every service to c be the property described above th apparent good order,except as noted(contents and condition of con- tents of packages unknown),marked,consigned,and destined as Indicated above which said camer Performed hereunder shah be sublet to all the bill of lading terms and conditions in the ova the word carrier being understood throughout this contract as meaningan sikcabon on the date of shipment. governing clas- possession of the property under the contract)agrees to carry to Its usuaplace of delivery atpmid desti Shipper hereby certifies that he is famlliar with all the lading terms and condfflons in the nation,It on its route,otherwiseto deliver to another carrier on the route to said destination.It is mutu- g-eming classification and the said terms and conditions are hereby agreetl to by the shi ally agreetl as to each comer of all or any of,said property over all or an accepted for himself and his assigns. Aper entl y porion of sold mule to dos — - CARRIER ]' PERP[ Zf — DATE Permanent post-office address of shipper. /!s�� 'IQ PRIMED ON RECYCLED PAPER STYLE F365-3 02003 LABEAASTER® (800)621-5808 wwwrMRb�a,X