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� t STRAIGHT BILL OF LADING ORIGINAL-NOT NEGOTIABLE Shipper's No. ` l k dV E Carrier's No. CARRIER: SCAC Dqite `TO: �� al'fI FROM: Consigne i tom�r!a b ij Shipperp-/ll "1 ✓tL - ✓Street �� I Street Destination Li'l �'t7 r - C � F, Zip Origin , Zi I Router Vehicle Number U.S.DOT Hazmat Reg.No. HAZARDOUSShipping Kind o •.• HAZARD CL SS Units (IF i f• I Remit C.O.D.to: C.O.D. Amt: C.0. D. FEE: Address: Prepaid City: State: Zip: $ Collect $ NOTE-Where the rate Is dependent on value,shippers are required to state specifically in writing ton0j!,thecun 7 of groo,ece.41If IlhssnpmeN ce!obsd!aeredlolhsro sgnee Thout a ameonthe FREIGHT CHARGES �onsydnor Ineoom!y,orenalsgnlnatowr.,,nssra!amam: the agreed or declared value of the property. The agreed or declared value of the property is The artkr haY ml make deWaryo 1hY shgmenlw hoot paymen oNreghl and a3 Nher xlul hvgas. hereby specifically stated by the shipper to be not exceeding $ Per sbnaareorconspnor) PREPAID COLLECT 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 opacity 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 Irabllity NMFC 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 there is no release or value declaration by the 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 shipper,and the shlpper does not declare a value r--<_ deliver to another carrier on the route to said destination.It is mutually agreed as to each carrier of all or an of said Property over all or an or release the carrier's liability,that liability shall y p ty y portion of said route to destination and as to each be limited to the extent provided by NMFC Item party at any time interested in all or any of said Property that every service to be pedorme6 hereunder shall be subject to all the conditions not prohibited by law,whether printed or written,herein 172.California it shipments 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 Uncitetlon for loss or damage In this shipment maybe applicable.See 49 U.S.C.14]06(e)(1)(A).and(B), s: This Is to certify that the above-named materials are property classified,described,packaged marked and labeled and are in proper condition for transportation according to the applicable regulations of the Department ofTranspodatlon. ,r YES NO-FURNISHED BY CARRIER Per SUPPLIED DRIVERS SIGNATURE: r SHIPPER: ' hsr.� /✓ £ _ � Cr✓�~ CAR IER: G ,.L#_' `{ PER: ' DATE: PER: e" DATE: EMERGENCY RESPONSE Monitored at all times the Hazardous Material is in transportation ' TELEPHONE NUMBER: ( � ) Including storage incidental to transportation(172.604). s; P TY1111•1• If" > i i ' a I