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I STRAIGHT BILL OF LADING - ORIGINAL- NOT NEGOTIABLE Shipper's No. Carrier 4I 44e.-:7 SCAC Carrier's No. RECEIVED,subject to individually determined rates or contracts that have been agreed upon In writing between the carrier and shipper,if applicable,otherwise to the rales,classifications and rules that have been established by the carrier and are available to the shipper,on request;and all applicable state and federal regulations; at , date from 23 •25/ the Property described below,in apparent good order,except as noted(contents and condition of contents of packages unknown),marked,consigned,and destined as indicated below,whit said company (the word company being understood throughout this contract as meaning any person or corporation in possession of the property under the contract)agrees to carry to deliveryal said destination,it on its route,or otherwise to deliver to another carrier on the route to said destination.It is mutually agreed as to each carrier of 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 of said Property that every service to be performed hereunder shall be subject to all the conditions not prohibited by law,whether printed or written,herein contained,including the conditions on the back hereof,which are hereby agreed to by the shipper and accepted for himself and his assigns. TO: FROM: Consignee 4tie4f:,e4 j�� 1 Shipper Z2 42m. , Street , ,lr its Street S ✓. Destination Y,9. 4,f . Zi 1!Y.!5-VV Ori in &, ✓ Zi J Route Delivering Carrier Vehicle Number U.S. DOT Hazmat Reg. No. • B o o P t.,esi-,I-,1e12,qq 1A,a sT45 . .. -..__- _ -.-- - ..........__....._._..- -_ ._...._. .tel aIs� _-- ................ .._.. _ . . _._.. Remit COD to: Subject to Section r d conditions, this ///�� COD FEE: shipment is to be delivered to the consignee ®® AMT: without recourse on the consignor, tha Address: consignor shall sign the following statement: Prepaid The carder shall not make delivery of this City: State: Zip: shipment without payment of freight and all ft, Collect other lawful charges. NOTE:Where the rate is dependent on value,shippers are required to state specifically in writing TOTAL CHARGES• FREfGHT CHARGES: the agreed or declared value of the property.The agreed or declared value of the property Is hereby specifically stated by the shipper to be not exceeding $ Per (Signature of Consignor) $ ❑Prepaid ❑Collect NOTE:Liability Limitation for loss or damage in this shipment may be sppllceble.See 49 U.S.C. •B 14706 c 1 A and 6. ® B a 9Y SHIPPER n BY CARRIER This is to certify that the above-named matelots are properly classified,described,packaged,marked and labeled,and are In proper condition for transportation according to the applicable regulations of a ® DRIVER'S the Department of Transportation. Per SIGNATURE: SHIPPER: C CARRIED: url�i� PER: '� DATE:T_ /7 _PER. ' " DATE: f,N:4,'RGEN �,r RESROH Q _ .�J' ��AME OR CO TRACT NUMBER T TELEPHONE- ;v�;MBER: —�7�b �7c>T `Z ]' OR OTHER UNIOUE IDEM T 14=E=: !7 3-BLS-C3 969(Rev.9/10)