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III* of IIpping uraer hnuU ut0 lbyluly tiftbu III,III Illn Illubllulb rb,lull,ul 111 Carbon,and retained by the agent Shipper No. / Carrier No. Page Of 'f� s�,G'G'�•�`��`��!/1�/1�/F�.�'F��li'� (Name of carrier) Date (SCAC) On Collect on Delivery shipments,the leffers"COD"must appear before consignee's name or as otherwise provided In Item 430,Seal. TO: FROM: ConsigneeStreet Stre — l�L CiY State `l` r �� Ci State, Zi �.. Zip Code ,> _ _ p Code 24 hr.Emergency Contact Tel.No. Route --- Vehicle No.of Units BASIC DESCRIPTION Number 8 Container Type HM Proper Shipping Name,Hazard Class UN or NA Number,Proper Shipping Name, TOTAL QUANTITY WEIGHT CHANGES UN or NA Number,Parkin Group (Weigh, Volume, Subject to 9 p of Hazard Class,Packing Group Gallons,etc.) Correction) RATE (For Carder Only) er y) PLACARDS TENDERED: YES O NO © REMIT Note—(1)Where the rate Is dependent on value,shippers are required to stare I hereby declare that the co.1lents 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 properiy is hereby specifically stated by the shipper to described above by the proper shipping b)Who.thenot per name and are classified, packaged, C�® � C.OX- FEE:--� a Where the applicable tadff pmvislons specify a Ilmitafion of the earrie.'s liability absent marked and Iehelled/plecardad,and are Amt: $ PREPAIl) i] a release Or a value declaration by the shipper and the shipper does not release Ir.all respects In proper condition for COLLECT 13 `J the camera liability or declare a value,the carder''liability shall be limited to the extnnl transport acr,^)-,1ing to epplieaDie Subject Io section 7 of Iha dilbna,it t ems bed vena;o me TOTAL provided by such provisions.See NMFC Item 172. imematlonel end national govemmental consigner w!mnm rowurua h .nm:g f �on,gnor_PnII sin Inc T� (3)Commodities requiring special or additional care or attention in handling or slowing regulations. IoNowing alatemeCHARuES J must be so marked and packaged as to ensure safe transporafion.See Section to of The tamer shell not make delivery of Ulis shipment Without et payment of Item 360,Blies of lading,Freight Bills and Statements of Charges and Section 1(a)of freight and all other lawful charges. FREIGHT CHARGES the Contract Terns and Conditions for a list of such articles. "_—._ _ FREIGHT PREPAID ChoiA 1x v cha,ges Signature - ... --'._.___.-lsiamsus or(:onWno�l---' ==box al E] sot to be RECEIVED,sub -^ nBt't ia° e° mlft( led to the el in apparent and tangs in erect on ties date of are issue of This Ba o!Ladmg, IL.alion and as to each party at any time interested in all or an said _iiiiiiiiii the property described above In apparent good order,except as noted(contents and condition n1 con• y Property,that every service to be lents of packages unknown),marked,rnnsigned,and destined as indicate which said carrier �d0°"�hereunder-shall be subject to all the bill of lading terms and conditions In the governing clas. (the word carder being understood throughout this contract as meaning on or m oration In _• slfrcation on the dale of shipment. ssession of the property ) g �, corporation - Shipper hereby certifies that he is familiar with all the lading terms and conditions in the nation.If on Its rote, erwise under delivercontract) another tamer on the roulel to said tleelinel ort it mi muti,_`l. governing classification and the said terms and conditions are hereby agreed to by the shipper and Ally agreed as to each carrier of all or any of.mid property over all or any portion of mid mule to ties- accepted for himself and his assigns. SHIPPE dl`"-+, CARRIER ►-- PER DATE ��;_7 Permanent post-office address of shipper. /� RIM PRINTFn nN RFryCf FD PAPER rrArr,—. STYLE F365-4 02003 LABELMASTER® (800)621-5808 WWW.labelMaster.com namr