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STRAIGHT BILL OF LADING ORIGINAL- NOT NEGOTIABLE Shipper's No. i' t ( b, Carrier's No. j CARRIER: SCAC Date ' TO: — C 1 ter✓, FROM: Consignee ` �� p „ Shipper L Street �� '�s t ®e Street Destination -ry +� E' � , Zip q� ` Origin Zip (; a Route: l)� Z�' ��" / • Vehicle Number U.S.DOT Hazmat Reg.No. m a t IiFfP's d�'1/ 'V� . C�'a y � ' f Lt% ? r's` vr m 01 r s 12te G` F . y . ro z Remit C.O.D.to: C.O.D. Amt: C. 0. D. FEE: ui I i Address: Prepaid ' e o City: State: Zip: $ Collect $ U) `ffi NOTE-Where the rate is de endent on value,shi ers are re uired to states ecificall in writin s genas awn7orua onaaon.,ntm;,hgment is tonea�maredtome on nee.;momre emeo ma U) 3 p PP 4 p y g oerslgnor,Necare'gna shal!signtheldlowingslatemenl: g FREIGHT CHARGES a the agreed or declared value of the property. The agreed or declared value of the property is Thecanierehall not make de1ferynitNschipmmlwAhmft p,yment of fret ghtandallolhe,lmf,,lcharges. hereby specifically stated by the shipper to be not exceeding $ Per PREPAID COLLECT � (S:gnalure of Comig�) W 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,classifications and Where the applicable tariff provisions specify a _1 - 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 liability NMFC Item 172), ? Wy. 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 there is no release or value declaration 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 said destination,if on its route,or otherwise to or release the carrier's liability 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 Item o 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 172.California intrastate shipments must comply o 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. + N NOTE: billty Limltatlon for loan or damage in this shipment may be applicable.See 49 U.S.C.14706(c)(1)(A)and(a). TUa his is to certiy that the atemm-named materials are properly classified,described,packaged,marked and labeled and are c 'T in proper condition for transportation according to the applicable regulations of the Department of Transportation. YES �NO•FURNISHED BY CARRIER � L1 DRIVERS SIGNATURE:par a � � I I SHIPPER: 'cam ` f ,�' - v _ CARRIER: PER: J ATE: PER: 4 &A) DATE: t 0 2a I EMERGENCY RESPONSE 4 C� Monitored at all times the Hazardous Material is in transportation TELEPHONE NUMBER: ( �00 ) / '/ including storage incidental to transportation(172.604). e 1 '11Rill Rimini