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Shippers No. <br />Carrier A SCAC Carriers No. — Rt- C YE ri .00Yerl dein-04.0y &eerie nett odes CP ,10111(1,1, Up,' 111 noting trehefien the cern. 0.1 ohlrfeef entsh,e0e ro !no ones theisrheoleina and roVA. that rave been riatai.thed by Ihe ,-11P c, any are lendable In the shippeu. rut elem., and all am/rondo slain and reorral retaliationo <br />line Word company Icnne understood throughout Mei contrert as rnewaing env pellet, norPntal,on Or Posncsshn nt the promny under nv oohhanh atrocs to merry to O00reerY at WI deehi‘abor 0 On 0. mate 0. Dawn.. to Oollver to another cooler on IIle route to sand destination. Its Indreary nerned as 00001, Garner char re any of said erOptely owe ma or ere/ oodton oc yap room to dotty...bon or,,, as to each DacY at any lane nactested In all Or any of seal Pteparty that evory service In bo petItatned hatoundet Shall be subtoof to all the conditions nal prolablied by law whether ponied or wroten rereen r.ontaince reloren9 1100 SOndirlOnS On the bar* hereof which ins hereby agreed to by the shipper and acroplor1 br htroself and niS artieCrns <br />FROM: <br />Shipper <br />Street <br />Destination __5hc ke—l-c>v‘_ 044- ZiP9_54- <br />Route <br />Delivering <br />a amity described below in Apparent goad order etc.ept Os noted (contents and c'endtlaa.ateol Mete is; na ergot, tekkh.c.n). marked. ed trek:. urth said ',moony <br />.,2atreij—frOrn <br />Description of Articles Hazard Pkg. <br />Class Grp. <br />Total Quantity <br />(mess. 50101110. 00 <br />activity) <br />Weight Class or C) isubleci to <br />Rate 0 cotrectkm) <br />0 c2-- $4',I/ 6(2/ <br />COD FEE: <br />Prepaid 0 <br />Collect LII $ <br />FREIGHT CHARGES: <br />Pre id Collect <br />0 BY SHIPPER U80 CARRIER <br />5,4..1 (3 Socon co...4qm a IN .sIV tro iec,,u,v Ihp Lcv,VO, 11.11,-r <br />01 V. <br />efh, 031,01 n.10 <br />,a• 1,0 '1,Wyet <br />COD AMT: <br />TOTAL CHARGES: <br />e <br />PLACARDS <br />SUPPLIED <br />DRIVERS <br />SIGNATURE: <br />SHIP ER: <br />PE <br />EMERGENCY RESPONSE <br />TELEPHONE NUMBER: <br />CARRIER. <br />PER: <br />_aitfaifl et 4" <br /> DATE0Y— <br />OR OTHER UNIQUE IDENTIFIER: <br />NOTE. Mum) It's rote Is dependent On Value, shipper; are Werner to state speclt.caity to willing <br />01.11 agreed or declared value Of me property The agreed or deClared Value of the property is <br />healltlY /Med. ally slated by the shipper In be not reseereng $ Per <br />NOTE: liability limitation for loss or damage in thls shipment may be applicable. See 49 U.S.C. <br />1 et AandEl. <br />PLACARDS <br />REQUIRED <br />CONTAINS HAZARDOUS MATERIALS