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_ STRAIGHT BILL OF LADING ORIGINAL-NOT NEGOTIABLE Shipper's No. Carrier's No. i CARRIER: SCAC Date TO: �f r' � tRti � FROM:2 11 an ,: r € - tat r 5 IR Consignee Shipper 2 t j Street >a _ w // Street pp Destination y Zip t. Origins t a.r ( Zip ; a Route: Vehicle Number J.S.DOS"Hazmat Rea.No E � ; } 0 �( I ° m 11101 I i€.- - `- Ik `� oc� > f ro i j L-J L71 Z �a I ♦sr 4 I }-€ ` .' .%4.s E V- .. ,. SSM Remit C.O.D.to: C.O.D.C ® DAmt: C. 0. D. FEE: w Address: Prepaid Collect o City: State: Zip: (n SUE7ecl to Section 7 of the cenddlons it shipment is to be derrvered to the consgnee wilhout receureb on the NOTE-Where the rate is dependent on value,shippers are required to state specifically in writing FREIGHT CHARGES (n nsgrwr the convignor shall very the s ship g sit withml - ¢ - the agreed or declared value of the property. The agreed or declared value of the property is The cart ershafmnmake delivery of lhu shipment ritho payment Gheight and all other law til chairs hereby specifically stated by the shipper to be not exceeding $ Per (s.,gnswreofconsignor) PREPAID COLLECT cc L Lu - 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 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 carriers liabl ity NMFC Item 172) t til except as noted contents and condition of contents of packages unknown marked,consigned,and destined as Indicated below which said company the word company beingunderstood if there is no release or value declaration by the (- Y p p g )' g p y( p y 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 -7i = 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:Liability Limitation for lose or damage in this shipment may be applicable.Sea 49 U.S.C.14706(c)(1 HA)and(a). _ of - This a to certify that the above-named materials are properly classified,described,packaged,marked and laled and are _ � t n proper condition fortransportaton according to the applicable regulations of the Department of Transportationbe. - (-�"IYES 11NO-FURNISHED BY CARRIER ` t = ? DRIVERS SIGNATURE: Per LOW SHIPPER:c;l, ✓—u- `t Z— C , w CARRIE1 i-'1 PER: ATE: -1--3 It Jr PER: DATE: EMERGENCY RESPONSE MonitorW at all times the Hazard us Material is in transportation TELEPHONE NUMBER: (� )C j C�j including storage incidental to transportation(172.604). .r,