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STRAIGHT BILL OF LADING ORIGINAL-NOT NEGOTIABLE Shipper's No. Carrier's No. CARRIER: SCAC Date TO: � QGa��G, FROM: lN+r� ^'( � 1 Constg�nte � '� Err A Shipper/q/12- �J f�l�C� Pte',oe Street F r,��rr-� 5 r� Street i �f� Destination ('��" / ``� Zip Origin SCK44vj Zip Route: Vehicle Number U.S,DOT I-lazmat Reg.No ' '5 ILIA _ 1 6: �" •/'y�7L�'6`i �JG,z( ��-L `?'cam/�� 3 I" 4e,- r ! at- Remit C.O.D.to: C.O.D. Amt: C.O. D. FEE: Address: Prepaid City: State: Zip: �° Collect $ NOTE-Where the rate Is dependent on value,shippers are required to state specifically in writing srn, Cosa 7alhecorvapm.itOw-ewa lel°c°akwe`aat°tne�n,aee° Inmare�a on the FREIGHT CHARGES mns'gnor,pa wnsgnor ahaY agn'he Iob�Jrg a'alcmanl• the agreed or declared value of the property. The agreed or declared value of the property Is Thep,dereha'Inol mkpdakveryollNsshpmeMWheat Payment WWOmawa1other haimeberaes PREPAID n COLLECT hereby specifically stated by the shipper to be not exceeding $ Per rsgaet—of eamgiwd 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 rates,cies ioaff ns and Where the applicable tariff pprovisions specify a rules that have been established by the carrier and are available to the shipper,on request:and all applicable state and federal regulations;the Property described below,In apparent good order, limitation of the carrier's Ile hm a Item 172), except as noted(contents and condition of contents of packages unknown),marked,consigned,and destined as Indicated below which said company(the word company being understood If mere is no release or value de are by the shipper,and the shipper does not declare a value throughout this contract as meaning any person or corporation in possession of the property under the contract)agrees to carry to delivery at sold destination,if on Its route,or oche wise to or release the carriers Ilabillty,that liability shall 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 be limited to the extent provided by NMFC Ilam party at any time Interested in ell or any of said Property that every service to be perforated hereunder shall be subject to all the conditions not prohibited by law,whether printed or wriden,herein 172.California Intrastate shipmeNs must comply contained,Including the conditions on the back hereof,which are hereby agreed to by the shipper and accepted for himself and his assigns. with NMFC Item 173. NOTE:Liability Limltallan for loss or damage In this shipment may be applicable.See 49 U.S.C.14709(c)(1)(A)and(a), �v This Is to certify(hal the abova.named materials are properly classified,described,packaged,marked and labeled And are , - \ /,(EIJ YES NO-FURNISHED BY CARRIER In proper cond tion for transpa.Info. according to the appheable regulations of the t opariment ofTamep.,tation. ' , fir( DRIVERS SIGNATURE: Por SHIPPER: w , r^� r'+'� � " CARRIER: S f PER: DATE: PER gam— ,�.1i�t0 DATE: L� EMERGENCY RESPONSE 111 Gam' , - Monitored at all times the Hazardous Material is in transportation TELEPHONE NUMBER: ( O� ) J including storage Incidental to transportation(172.604).