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STRAIGHT BILL OF LADING -3q3 ORIGINAL-NOT NEGOTIABLE Shipper's No. ,101 " Carrier's No. ARRIER: SCAC Date 1 0: P�)��►� �� „4� FROM: Consignee / Shipper IL11 L r ::I Q,,,J Di",ve Street �5'1 Ice /Za Street Destination 5oi 6 Zipgg-719 Origin i ` Zip ` 62,05 1 Route: Vehicle Number U.S.DOT Hazmat Reg.No. I = Kind of Packages,Description of Articles HAZARD LD� Packing z,. HAZARDOUS •�• .- Group r: 1 2-0 Gt 3 7 �1��r�i�, w �trz� � 7 \ x 7� JL f r t ,kl� ..�...�. `�"r'W � t �Y 3 LSV_J JL�"l�i"rt.-- •G J Y ' ^ Remit C.O.D.to: C.O.D. Amt: C. 0. D. FEE: Address: Prepaid City: State: Zip: Collect $ 6edect to Sec6an 7 of the condAlom,if Ilan sh'yment Is to be dencred to the cortsignae without recourse on the NOTE-Where the rate is dependent on value,shippers are required to state specifically in writing FREIGHT CHARGES cunsgrror he "it,-1.ds'.a,.l 1ld owrngstalemcnl ; the agreed or declared value of the property. The agreed or declared value of the property is rneoarderehegr�otmakeaes�erymtha:ny�mt„them paYme�Aonregtnand avother Ia.wmcharges. PREPAID COLLECT j hereby specifically stated by the shipper to be not exceeding $ Per (sqnmreofcowgnor) 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 fFrovlsions specify a s fi 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 Iiabllity 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 beingunderstood If there is ai release or value declaration v the - p l p g )' g p y l p y shipper,and the shipper does not declare a value ,lghout 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 carriers Iiabllity,that liabilityry shall 'r 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 lc the extent provided by NMFC Item 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 '- sined,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 Lire talion for lose or damage In this shipment may be applicable.See 49 U.S.C.14706(c)(1)(A)and(B), This is to cerllty Ihat the above named materials are properly classified,described.packaged,marked and labeled and are t r in proper Gond tion for transponaton according to the applicable regulations of the Department of Transportation. ,, PLACARDSYES NO-FURNISHED BY CARRIER r Ye- JSUPPLIED DRIVERS SIGNATURE: Par SHIPPER: Lal" Jr 1" ✓ �- 4, 1i CARRIER: a7.W rlflii PER: DATE: 173 yO L col 9 PER: DATE: d EMERGENCY RESPONSE 4 Monitor at all times the azardous Material is in transportation TELEPHONE NUMBER )� 7 including storage incidental to transportation(172.604). a � t A t •1� A t I i !ft I' i 3 p i e f E7 i