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lxarcadt Lttrffia7BW( ttl This $hipperNor amor ldb ofs° rwaf t tt ' „ i t wR r�rd:. Carrier No. e Page O$ - (l�rrte ofr;erp (SCAC) Datey/rb2. .QO ceusa km OMwy. b.Mbm,�'�e6.Opwe .>,wnsaroMeMM PmMdxe ln-IMa.7A 8nn 1. TO: r Consignee �J00� ftl,! + j Street Street 1P -T j/ City State / Zip Code City State e Mp Cute 24 hr Emergency Cwrtact sell. Route Vehicle Number No.of Unitsg�`® Sash DESCRIPPTON TOTAL QUANTITY WEIGHT CHARGES. HM &Container Type Paper Shipping Name,Hazard Class, (Weight,Volume, idenfification Number(UN or NA),Packing Grow 172.101,172.202,172 203 (Subject to RATE (For Carrier g Gallons,etc.) Correction) Use Only). 7 �. I L i i PLACARDS TENDERED:YES t= NO'®. REhfiT Note—(1)where the rate Is dependent on value. are reyhered to stato- I hereby declare that the conards this ADDRESS _ specifically in wrting the agreed or declared value of the property.as bhms:"The - agreed or declared value of the property is hereby specifically std by theshOper to desaW�atffitove the ro mately be not exceeding per - primer C.O.D.FEE: 12)Where rte name and are tlassghd Packed. CODs. Amt: S PREPAID El e,or a value term patios by,spisay a xmhhe i the does not release marked ant and era abeam a release or a value declaration by the shaper anal to sl�perdoea r�release. h�at r�pecb h proper cerhdxion tar COLLECT 0 $ Me carders xabtty or declare a vakm to carrier%liability shelf be xmxed to treextent traneput to ro ,)of the arkx t tris shipment is to be delivered tothe provk l by such provisions.See NN IFC kern 172. hternebonal mrd gwernerre corm wthMA MMUM®on the consignor,the consignor shall sign the Mcommodmes requiting special or additional care or attention ertion in handior s CHARGES: S' . must be.so made and packaged as to ensure soh. See section 2(js. The rertsh�i make deltvery_of tfAs-shipment wiMoutpayment of height and at other hwhd charges FREIGHT CHARGES Of itemC3 Bxh ffi Lading,Fref�tt Bxh eM$tatenams of Charges and Section 1(a) - FREIGHT PREPAID Chw1 bra x Of the Contract Temps arW COndixorhs fer a list Of si1Ch ambles. Signature t 1 dwclkee ar 171 mem RECEIVER sublect to classilicallons and farms h on the dale ofthe I=*of tris Ba of lading, - - ihatim and as to each at pr�arty da Aad aDo�s h apparent good order excep<ffi need(catems andcarhAtlon of porn - pafamed hereunder shalt be s,A ct m.all the igoh same old conditions any said propertytinhat f service ro be (ta wad unkrwwn),hnarked and destlrad�hdirand above-wfxdt sdid garter - -s'dreatar ortthedaNaer --- .,. governig chs- f> ,a,q taagltpt tlhh r;Orlifect ee rraarxrhg erry person or anpOraton h Shyper hereby OB(tf tum to is f mill r with alf:Ahe bill Of lading terns and conditions in to possessierh of the property caber txmaect) ro cffiry ro xatsttdi plea qt deWary ffi sob Gest gs»-classification and the—said,terms and conditions are hereby agreed to by the shipper and nation.lf on�Mull,other,vfia ro de4vwro Carder on tfhe rghua rosab destkaton.tt b mar .aocelked IN hikaat>.a d his assigns.: st}y agreed a&b eat�h comer Of 8♦erarhy d,said properly 01Bf8t d ar7 pfMkth d saki mute rodeo- SHIPPER �j y CARRIER PER PER - GATE 5- 6/,7/- Permanent post-office address of shipper SME F26"*LAKLIOWMO(sOM 621-UN www, cora vsrreooHamq%®wa e«n.: Isaasoreawwq haat. - "