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STRAIGHT BILL OF LADING ORIGINAL-NOT NEGOTIABLE Shipper's No. Carrier's No. CARRIER: SCAC Date TO: �C '� O // FROM: .C��wy` P�•,� i r� ��"o �H Consignev ��N+I(t S Se`^� r l Shipper/c/GZ Street Street Destination / Zip a,7 floe3 Origin �� zipg Route: �f1/_�J Vehicle Number U.S.DOT Hazmat Reg.No. 1�5 30 0 u � HAZARDOUS .. -D shipoin a � •.•ER SHIPPING NAME) CLASS5 ,) r ' ?� � �lV� ✓t�oh� e�-s � 1V,O 19 !,e�rd�-S e t Remit C.O.D.to: C.O.D. Amt: C. O. R FEE: a { Address: Prepaid aid t City: State: Zip: $ Collect $ } 18*71t.SI.lion 7 of the ,d llhs slyp(decl Is to b6 deve•ed to the cons yee n.Ihcl recaase on the NOTE-Where the rate is dependent on value,shippers are required to state specifically in writingFREIGHT CHARGES ,y consgnm the ocnsgocr shat x(In the lo.cMrg fha�emenl 1 the agreed or declared value of the property. The agreed or declared value of the property is The—ne i4iol net wko d0mry of lh-a t-ot ldolt PaYmenl N lreyhl I'd"I other laMd 0xvit a f hereby specifically stated by the shipper to be not exceeding $ Per (sanxareof com.gdcd PREPAID COLLECT RECEIVED,subject to Individually determined rates or contracts that have been agreed upon In writing between the carrier and shipper,If applicable,othervAse to the rates,classifications and Where the applicable tariff provisions specify a x .,as 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 Ilabi lty 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 s there Is of release or value declaration by the throughout this contract as meaning an arson or corporation In possession of the property under the contract agrees to car to dative at said destination,If on Its route,or otherwise to shipper,and the shipper does not declare a value g 9 y P P P P P Y ) 9 carry delivery or release the carrier's liability,that liability shall 3 deliver to another carrier on the route to said destination.It is mutually agreed as to each carrier of all or any of said Properly over all or any 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 performed hereunder shall be subject to all[tie conditions not prohibited by law,whether printed or written,hareln 172.California Intrastate shipments must comply contained,Including the conditions on the beef(heroof,which are hereby agreed to by the shipper and accepted for himself and his assigns. with NMFC Item 173. qq NOTE:Llablllty Umltetlon lar lo..or d.m.ge In thh shipment may be applicable.Sea 49 U.S.C.14706(c)(1)(A).ad TI is to cert ly Ihat the of named materials are properly cassilled,described,packagod marked and labeled and are y je � (L to proper o..d tion for hanspotlallon accord ng to the applicable regulations of tho Depadment of Transportation MZYES []NOt-,X JRNISHED BY CARRIER �' '' DRIVERS SIGNATUOE: Per IF SHIPPER: �..N►� �'e ,^p r CARRIER: .u� a1J► '�— PER: DATE: PER: DATE: �,94 -, EMERGENCY RESPONSE //�� /' �—^ r Monitor at all ti es the Hazardous Material is in transportation TELEPHONE NUMBER: (Go `v including storage incidental to transportation(172.604).