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STRAIGHT BILL OF LADING ORIGINAL-NOT NEGOTIABLE Shipper's No. CARRIER: SCAC Carrier's No. Date TO: Pk1 ry Tec, 3z,,, �nv. FROM: Consignee -. )ry)��Q n�'] Shipper/,-//2_ Street 5 j V R V P" � Destination S ✓',` S s g Street / � _ �� Zip .t� ,� Origin �v�.� - Zi p 5 . Route: Vehicle Number U.S.DOT Hazmat Reg.No. CLASS . . 15Y f' rr y .�t .'jA, 1, 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 semacnesocron7ofthecoad:cone.0IN,shpmenl blebedeveradtothe co gneenrhoolr oWaeenma FREIGHT CHARGES € mns!fexs.the cons!gnor<ha!1 sign the Io::oF. ng alatemenc the agreed or declared value of the property. The agreed or declared value of the property is The cemershal not make de::veryoflhsshomenl ntlhoul paymcni oflre'.ghtand alolher laWicharges. hereby specifically stated by the shipper to be not exceeding $ Per (sgmwreo1Consgwr) 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 specify a rules that have been established by the carrier and are available to the shipper,on request;and all applicable stale and federal regulations;the Property described below,in apparent good order, limitation of the carriers liability Isle Item i y a �o 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 shipper does not declare a value 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 carriers liabllitg that liability shall Y p rty y portion of said route to destination and to to each be limited to the extent provided by NMFC Item party in 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 - contained,including the conditions on the back hereof,which are hereby agreed to by the shipper and accepted for himself and his assigns. with NMF Item 173. NOTE:Liability Limitation for lass or damage In this shipment may be applicable.See 49 U.S.C.14708(c)(1)(A)ond(S). This is to cerlity,that the above.named materials are properly classified,described,packaged,marked and labeled and are . •, in proper condition for transportation according to the applicable regulations of the Depanment of Transportation. r BYES P NO.FURNISHED BY CARRIER ` Per r• `fSUPPLIEDDRIVERS SIGNATURE: SHIPPER: �1; irk ie,-V roy-1, CARRIER: r" PER: DATE: 3 0,619 PER: DATE: J v EMERGENCY RESPONSE Monitore at all ti a the Hazardous Material is in transportation TELEPHONE NUMBER: ( g .3 including storage incl ental to transportation(172.604). P I 1111a •I S - a • r _ t x