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STRAIGHT BILL OF LADINGmill III
<br /> ORIGINAL-NOT NEGOTIABLE Shipper's No.
<br /> CARRIER: SCAC Carrier's No.
<br /> + Date
<br /> TO: Q ✓�o., • • '�' 2 S L FROM: �j�1/tir+t P.•� / i
<br /> Consignee _5- �id✓' 8 '^Q Shipper l ,� '` v� v{' �f
<br /> (; m Destination '^"'r l�C✓ Streets n
<br /> a Route: Zip Origin /' Zip q,5 Lo
<br /> E icle Number U.S.DOT Hazmat Reg.No.
<br /> Kind of Packages,'Shipping "Aim-
<br /> HAZARD [Lei;
<br /> Units 1:; (IF HAZARDOUS MATERIALS-P.•,. Articles
<br /> ER
<br /> SHIPPING NAME) CLASS
<br /> JJJM 77 5,oviaA aza I
<br /> 3077
<br /> N
<br /> Co 79
<br /> m � i
<br /> Z
<br /> r-
<br /> ? Remit C.O.D.to:
<br /> rn Address: C.O.D. Amt: C.0. D. FEE:
<br /> 1 Prepaid
<br /> o' • CIS' State: '
<br /> Zip: � Collect ft $ }
<br /> NOTE-Where the rate is dependent on value,shippers are required to state specifically in writing ms 'a"x�dsw,.rmu,naMm umoedx.,drow„o�gr,,md,,,,,,�,.,W
<br /> a the agreed or declared value of the property. The agreed $declared value of the property is n„a„b„n:�a�.+,�„y,"",,UkWi"°o a q a FREIGHT CHARGES
<br /> 11:ed' hereby specifically stated by the shipper to be not exceeding $ Per
<br /> (sigaaeaedo—J7 q PREPAID COLLECT
<br /> wW 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 rovtsiona specify a
<br /> 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
<br /> Y: except as noted(contents and condition of contents of packages unknown),marked,consigned,and destined as indicated below which said tom apparent good order, Iimhatlon of the carriers liability NMFC Item 172),
<br /> throughout this contract as meaning any person or corporation in possession of the props under the contract company(the word company being understood If there is no release or value declaration by the j
<br /> i deliver to another carrier on the route to said destination.It is mutually agreed as to each caller of all or a t)a ees to tarty to delivery at said destination,if on its route,or otherwise to shipper,and the shipper does not declare a value i
<br /> o party at any time interested in all or any of said P every pe any Property over all or any portion of said route to destination and es to each °f release the carriers liability,that liability shay
<br /> roperty that eve service to be performed hereunder shall be subject to all the conditions not rohlbhed law,whether tinted or written,hereto 172 limited
<br /> imr state provided by NMF hem
<br /> N contained,including the conditions on the back hereof,which are hereby agreed to by the shipper and accepted for himself and his assigns. p p shipments must comply
<br /> NOTEt., Llmuatlon torbas or-muga infhb ahi gX�xdxN and(B). with NMFC hem 173.
<br /> t Pmanr may M applinbN,as ag U.S.C,ta7
<br /> pr This Ls to only ave the above-nametl mntnrieb aro ProPnrN dafsified.de—bed.Packaged.marked and Inbnled and are
<br /> 'a h P'oPer corWitlon fortransPortatlx
<br /> on aoNirg b the applkaNe ragulatioru of the Depernnem ofTravportation. • •P A 1
<br /> �, �I Por P •• t (�//' • a ES [I NO-FURNISHED BY CARRIER
<br /> r •• DRIVERS SIGNATURE:
<br /> SHIPPER: rfj w irr+ CARRiE
<br /> PER:
<br /> DATE: PER: DATQb
<br /> EMERGENCY RESPONSE fteog�_Monitored at all times the Hazardous Material is in transportation
<br /> TELEPHONE NUMB R: ( ) Gj^3 including storage incidental to transportation(172.604).
<br /> P
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