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c)C The format and content of hazardous tern list is the responsibility of individual com- pany interpretation of requirements as described in 49 Code of Federal Regulations 172, Subpart C-Shipping Papers. Such description consists of the following per Sec- tions 172.201 (Hazardous Materiel Table) and Sections 172.202 arid 172.203: Proper shipping name, t; ; .ous class, UN identification number, pecking group. and subsidiary cles Aft, Note: Liability limitation for It or damage in this shipm may be applicable. See United States Code. Secti 114706(c [1 )[A) andx(B). CARRIER PER (-) • _ ncy Pesponso Phone Nu bor. ,i,meree I. ; *eel-lint IP nrnolTIOncy • . IV' 41. Dat,n ink """ Nfo Stree t Destination 1/ Route: units Consi nee 4-HM [Noma of Carrier) FROM: Ship Dill al I. riding Na Shipper Na. Corricr No. Or - Code rn" Vehicle No. Kind of Packaging Special NI . Description of Articlan c:yrn"ticnnlurefitns.be7flos.rnthm'e"grio":atnelniTpisnrredlisedet"d nruirl"wintjmi. inshend4riurux.ngoom..60u, of Natitmol Motor Freight Dess,hcatton. item 3 On fl —a. nS and EXCepLiOnS Zip Code Emergency Response Phone Number Rate or Class CHARGF_S TOTAL. CHARGES: $ FREIGHT CHARGES Check Appropriate Bac 0 Freight prepaid 0 Collect RECEIVED, subject to the classifications and lawfully filed tariffs in effect on the date of the issue of this Bill of Lading, the property described above in apparent good order, except as noted (careen and condition of contents of packages unknown), marked, consigned, and destined as indicated above which said carrier (the word carrier being understood throughout this co ited. as meaning any persi or corporation in possession of the property under the contract) agrees to carry to its usual place of delivery at said destination, If on its route, otherwise to deliver to another carrier on the route to 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 party at any time interested in all or any of said tv-7 erty. that every service to be perfortned hereunder shall be subject to all the terms and conditions of the Uniform Domestic Straight Bill of Lading set forth (1) in Uniform Freight Classifications in effect the date hereof, if this is a rail or a rail-water shipment or (2) in the applicable motor carrier classification or tariff, if this is a motor carrier shipment. Shipper hereby cerdfies that he is familiar with the terms and conditions of the said bill of lading, set forth in the classification or tariff which governs the transportation of this shipment, arid the said terms and conditions are hereby agreed to by ' shipper and accepted for himself and his assigns. Mark with "MT if appropriate to designate Hazardous Materials as defined in the U.S. Department of Transportation Regulations governing the transportation of hazardous materials. The use of this column is an optional method for identifying hazardous materials on Bills of Lading per 172.201(811) fili) of Title 49 Code of Federal Regulations. Also when shipping hazardous materials, the shipper's certification statement prescribed in section 172.20.4(a) of the Federal Regulations, as indicated on the Bill of Lading does apply, unless a specific exception from the requirement is provided in the Regulation for a particular material. *If the shipment moves between two ports by a REMIT carrier by water, the law requires that the bill of lading C.O.D. TO: state whether weight is 'carrier's or shipper's weight—. ADDRFSS Note--Where the rate is dependent on value, shippers are required to state specifically in writing the agreed or declared value of the property. The agreed or declared value of the property is hereby specfically stated by the shipper to be not exceeding per Subject to Section 7 of the conditions, if this shipment is to be delivered to the consignee without recourse on the consignor, the consignor shall sign the following statement. The carrier shell not make delivery of this shipment without payment of freight and all other charges. C.O.D. Amt. $ C.O.D. FEE: PREPAID 0 COLLECT 0 $ )Signeture of Consignor) SHIPPER PER This is to certify that the above named materials are properly classified, packaged, marked, and labeled,. and are in proper condition for transportation according to the applicable regulations of the U.S. Department of Transportation. — :•4*tr. • Carrier acknowledges receipt of packages and a red placards. Carr er certifies emergency re nse int don was made available and/or carrier has the partment of Transportation emergency response guic or equivalent documentation in the vehicle. Property described above is received in good order, except as no Scanned with CamScanner