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<br />PAN: (Company Name) &
<br />a-----------,--'-
<br />0A, DATETR PPED
<br />SHIPPER'S NO.
<br />AT
<br />r— &q a0i
<br />ly
<br />110427
<br />BY A -V
<br />CARRIER
<br />CONSIGNED TO (Mail or street address for notification on/
<br />11, 01,011, d*—Mied bell-, 1 p,,,,, plef ,do,, a -rep, as ..hsd and
<br />Subject 10 Section 7 Cd Conditions or
<br />,.rd, n .1 1, rt.— of packages unknown), marked, —.9ned, and destined as indicated
<br />.,ofleabl. bill of lading, 4 this 1hip-
<br />below, which said carrier (mr, mid ca -I, being understood in roughout this conf,w as
<br />mar -I .1 1. ce deh—cl to the coM,9.
<br />mean ng any person or cortioration in ansairs on of Me plocanty under the contract) norms
<br />mo .0-1 r6cqurN on 11. cansugoor.
<br />4
<br />1 10 11 11,11 Place .1 dich—, a, said destination, it on I" 'Out., otherwise to del—,
<br />:
<br />he shelf sign the
<br />lotlowirp
<br />. .011" farrier on In, -11 11 ,,it dlll,,,t,,n. 11 11 1111*11Y agreed. 11 11 1111 *1
<br />all or any of .I(, "am .— all ., any portion of said 1. drehostrus., ad .. to
<br />.1-1-iman.
<br />cl P, r r
<br />each party at any time interested in all or any of mid Property, that early selvice to be
<br />for
<br />Th@ carnar &hail not make dishmay
<br />road hereunder &hall bei subject to .11 he unist, Ind conditions of the Unit.,. Do-
<br />of this shipment without pinneseent of
<br />I
<br />mastic Straight 8,11 of Lading act forth (1) in Uniform Freight classification in effect on
<br />freight and all 0", fateful Charges.
<br />the date ",Sot, if this II a rail or arail-water shipment, or (2) in the applicable Moto,
<br />,1., 0-0 ".Iran or tariff if this if . motor wrrror shipment.
<br />(Siqnahm, of C.M.9near)
<br />Ship— hereby .reifies that he Is familiar with all the terms and conditionsof the mid
<br />bill of lading. Including those an Ille back thereof, set forth in the classification or tells:
<br />governs gos the transportation of this shipment, and the mid term$ and condition
<br />ale hereby agreed to by the shipper and accepted for himself and his inangris.
<br />F
<br />OPREPAID
<br />If In,, do--., evidence, a delivery by hipoir,'. truck or into ..Can., truek, i[
<br />is not a bill of lading but consignee's receipt for the delivery.
<br />COLLECT
<br />ROUTE
<br />ORDER NO.
<br />SHIPPING MEMO
<br />NO.
<br />ROUTECODE CAR/TRUCK NO. SEAL NO CUSTOMER ORDER NO.
<br />MATERIAL TRANSFER
<br />PACKAGES DESCRIPTION OF MATERIALS, SPECIAL MARKS AND EXCEPTIONS
<br />WEIGHT* CLASS 3: 0
<br />Subject to TOTAL VALUE W
<br />OR
<br />NO. KIND D.O.T. HAZARDOUS MATERIALS, IF ANY, MUST BE LISTED FIRST
<br />correction RATE OF ITEMS Z
<br />... .. .. ....
<br />TOTAL NO. OF PACKAGES TOTAL WEIGHT
<br />COLLECT ON DELIVERY REMIT TO
<br />C.O.D. CHARGE
<br />$
<br />TO BE PAID BY
<br />®SHIPPER 1:1 CONSIGNEE
<br />PURCHASE ORDER NO.
<br />INVOICE NO.
<br />REASON FOR SHIPMENT
<br />APPLYING
<br />TO 2�
<br />SETTLEMENT BASIS
<br />SHIPMENT AUTHORIZED RY
<br />CREDIT MEMO CASH SALE® MEMO
<br />ISSUE BILLING TO
<br />/ ?P3�1
<br />MAIL :-HEIGHT BILL IN DUPLICATE WITH NO. 3 COPY OF BILL OF LADING TO
<br />�:,71, rw
<br />'AkTiAt XMI- i'a P kU" A
<br />"s, � �, ; - i
<br />FA
<br />run rmuuut; I tPqt:KUtNt;Y ---SHrPf I Afil ENTS MATERIALS PLACA111011 FURNIS11,1110 aryl
<br />Spill. Leak, Fire, Exposure or Accident 800-424-9300 [
<br />CALL CHEMTREC -DAY OR NIGHT � 0, MOTOR CARRIER SHIPPER CARRIER• —
<br />If the shipment moves between two ports by a carrier by water, the law requires that the bill of lading shelf state whether it is "carder'sfor thipper'stao'
<br />1. The liessed an dischread yalike of tel Vernearty, is hereby alklakitically listed by tel thippM to be fast excooding 150 If Per seasond
<br />whose tel meas is dependent on vehae.
<br />2. D—nitwit ad seem "might thereof as almost hotel. are amerism, per AV—MIMI filed with Weighing and Intimation assmor, Carrier certifies that the container supplied by Carrier for this shipment is a
<br />if applicable.
<br />3. Thos it to seartilly that be be,. marrad nualiferials .1. Properly clarefisel, skinflints. track", markedand labeled and proper container for transportation of the Products as above described.
<br />larcraor cand"ism for tinaniftertation assiciardling to the applicable negulatiorut of the Deparromat of Transportation. CARRIER
<br />s, -,Pi.�70 W,
<br />Ilk
<br />SHIPPER (Company _ff=e)" 7,
<br />PER PER
<br />PGENT
<br />MATERIAL RECEIVED` DATE RECEIVED
<br />ACCOUNTING
<br />
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