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STRAIGHT BILL OF LADING <br /> ORIGINAL- NOT NEGOTIABLE Shipper's No. <br /> a� <br /> Carrier's No. <br /> CARRIER: SCAC Dale <br /> TO: r/ '�9"'�, FROM: 5 AA Y111 eti flbi 'e 'Poetict[, <br /> Const nee Shipper a <br /> Street i T � d`� (Z I s i � <br /> Destination �`s/ C Zi L Street I ( ✓`t <br /> p Origin 7C�� d1 . { Zip 1 <br /> z, <br /> Route: ^G - Vi le Number U.S.DOT Hazmat Reg.No. a <br /> � ✓/�/� <br /> Sfov <br /> / f <br /> 17r-- <br /> i 4 d <br /> -V <br /> Remit C.O.D.to: C.O.D. Amt: C. 0. D. FEE: <br /> Address: <br /> Prepaid .t <br /> .gam <br /> City: State: Zip: $ Collect $ s t <br /> DOTE-Where the rate is dependent on value,shippers are required to states specifically in writing sab,eeuos 1 inn wall nm mpm.ot I3mbed;ws,odtothe carsgnesWil coo,asaanthe <br /> } ` <br /> p PP q p y g aanegn«to shat s,g,the f .ngslatemeal FREIGHT CHARGES <br /> he agreed or declared value of the property. The agreed or declared value of the property is The."I,,n s 1 k de.`. ,y fIn hpment Qf ut poll of fe,ghl and oother Il lcharges. r <br /> lereby specifically stated by the shipper to be not exceeding $ Per (sgaaNreofGal PREPAID COLLECT <br /> 1ECEIVED,subject to individually determined rates or contracts that have been agreed upon in writing between the carrier and shipper, <br /> 9 P 9 pper,if applicable,otherwise to the rates,classifications and Where the applicable tariff provisions specify a <br /> ules 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 liability NMFC Item 772), <br /> acept 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 there is no release or value declaration by the <br /> lroughout this contract as meaning any person or corporation in possession of the property under the contract)agrees to carry to delivery at said destination,if on its route,or otherwise to shipper,and the shipper does not declare a value <br /> leliver to another carrier on the route to said destination.It is mutual) a reed as to each carrier of all or an of said Pro a over all or an or release the carrier's liability,that liability shall : <br /> Y 9 y Property y portion of said route to destination and as to each be limited to the extent provided by NMF C Item ''€.= <br /> arty 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 t72.California intrastate shipments must comply - <br /> ontained,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. <br /> TOTE:Liability Limitation for loss or damage In this shipment may be applicable.See 49 U.S.C.14766(c)(1)(A)and(B). <br /> Ii s s to certify that the above-named materials are properly classified,described,packaged,marked and labeled and are <br /> 3: <br /> i proper condition for transportation according to the applicable regulations of the Department of Transportation. r �-� , YES [I NO-FURNISHED BY CARRIER <br /> Per <br /> ' DRIVERS SIGNATURE: <br /> SHIP R: Llv��i ° F lr a� r e� �c c 5 C r^✓� o� vc,_ CARRIER:- Joe <br /> PE DATE: PER: DATE: <br /> EMERGENCY RESPONSE , Monitored at all times the Hazer oa s Material is in transportation � <br /> TELEPHONE NUMBER: ( � °) ' t j including storage incidental to transportation(172.604). <br /> f€ i • IYMIMI 1 <br /> fulill <br />