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1 hib IWtMUHANUUM <br /> Is an aclancialmligimerm Mat a bill of Wing has be.Issued and is riallifili0riginal Bill of 1-ailing,nor Shi&'s No. <br /> a copy or duplicate,covering the properly named herein,and is irrt*Wery for filing or record. <br /> Carriees No. <br /> CARRIER: ki A Al' < SCAC Data I <br /> '111Lr V <br /> TO: I ' FROM: <br /> Consignee / K � 0 U- Shipper <br /> -r- <br /> J6 <br /> 61124EQ- <br /> Street ( Street 3 t nl <br /> 2 <br /> LO <br /> D <br /> A <br /> Zip 14- Origin ".7,Z Zip <br /> Destination Kcir'leo 1 5 _Y_KT01Q <br /> R?Ut9: Y Vehicle.Number U.S.DOT Hazmat Reg. No. <br /> • <br /> .......... <br /> ........... ............... ...... ...... <br /> .......... ........ .......... <br /> .......... ...... ........ .............. <br /> Remit C.O.D.to: C. 0. D. FEE: TOTAL CHARGES: <br /> Address: COD Prepaid 0 <br /> City: State: Zip: AMT: $ Collect 0$ $ <br /> *If the shipment moves between two ports by a carrier by water,the law requires that the Subject to Section 7 at condldorrs if this shipment is to be delivered to the consignee without <br /> bill of lading shall state whether it Is'carrier's or shipper's weight. recourse on the consignor,the consignor shall sign the following statement: FREIGHT CHARGES <br /> Note.-where the rate is dependent on value,shippers are required to state specifically in The carrier shall not make delivery of this shipment without payment of freight and all other lawful FREIGHT PREPAID <br /> writing the agreed or declared value of the property. charges. Except when CHECK BOX <br /> The agreed or declared value of the property is hereby specifically stated by the shipper box at right F-1 if changes are <br /> to be not exceeding -per (Signature of Consignor) I is checked I I to be collect <br /> RECEIVED,subject to the classifications and tariffs in effect on the date of this 801 of Ladl.ng,the%property described above in apparent good order,except as noted(contents and condition of contents of packages unknown), <br /> marked,consigned,and destined as indicated above,which said company(the wotdcompany being understood throughout this contract as meaning any person or corporation in possession of the property under the <br /> contract)agrees to carry to its usual place of delivery at said destination,if on its own road or its own water line,otherwise to deliver to another carrier on the route to said destination.It Is mutually aWeed,as to each carrier of <br /> all or any of said property over all or any portion of said route to destination,and as to each party at any time interested In all or any said property,that every service to be performed hereunder shall be subject to all the <br /> conditions not prohibited by law,whether printed or written,herein contained(as specified in Appendix B to Part 1035)which are hereby agreed to by the shipper and accepted for himself and his assigns. <br /> This is to certify that the above-named materials are properly classified,described,packaged,marked and labeled and <br /> are in proper condition for transportation according to the applicable regulabons of the Department of Trans nation. PER: <br /> SHIPPER: • ;'v . <br /> CARRIER:vUS <br /> PER: DATE: PER-,r:'Z`bli4i-71_) ACilic- DATE:;7 <br /> -7 <br /> EM GEN•`t- SPONSE__ MONITORED AT ALL TIMES THE HAZARDOUS MATERIALS IS IN TRANSPORTATION, <br /> TELEPHONE NUMBER: INCLUDING STORAGE INCIDENTAL TO TRANSPORTATION(1172.604). <br /> 30-BLS-C3 <br />