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sign 1414 66 Ala 61,0 r TiOpmp 5 ita &Le/JD wo of; 5 - Street .44 f'/ g 0' -1 (.5 Street Destination ( Y/6AA 11/1( (ill— Zip Code Origin r- /V a/u , (i-i' ' Zip Code Route: Vehicle No. SCAC Emergency Response Phone Number No. Shipping Units +HM Kind of Packaging, Description of Articles Commodities requiring special or additional care or attention In handling or stowing mu..it be so marked and packaged as to ensure safe transportation with Special Marks and Exceptions ordinary care. Sea Section 21o) of National Motor Freight Classification. Item 360. Weigi t JSubject to Correction)• Rote or Class CHARGES Vri fit V t)//U f il 1/ 09 -7 r? u c t." If the shipment moves between two ports by a , carrier by water, the law requires that the bill of ladin9 state whether weight is 'carrier's or shipper's weight. REMIT C.O.D. TO: ADDRESS C.O.D. Amt. $ C.O.D. FEE: PREPAID 0 COLLECTO $ TOTAL CHARGES: $ 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 specifically stated by the shipper to be not exceeding S 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 shall not make delivery of this shipment without payment of freight and all other charges. FREIGHT CHARGES Check Appropriate Box: • Freight prepaid 0 Collect . (Signature of Consignor) . RECEIVED. subject to the classifications end lawfully filed tariffs in effect on the date of the issue o this I o e property escri e a ove in apparent goo order, weep as no con n and condition of contents of packages unknown), marked, consigned, and destined as indicated above which said carrier (the word earner being understood throughout this contract as manning any pursuit 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 ED 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 party at any time interested in all or any of said prop- erty, that every service LO be performed hereunder shall be subject to all the terms and conditions of the Uniform Domestic Straight Bill of Lading set forth (1) in Uniform Freqjht. Classifications in effect on tile date hereof, if OHS 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 cerufies that he is familiar with all the terms and conditions of the said bill of lading, set forth in the classification or tariff which governs the transportation of this shipment, and the said terms and conditions are hereby agreed to by the shipper and accepted for himself and his assigns. Mark wen 'PO' if appropriate to designate Hazardous Materials as defined In the U.S. Department of Transportation Regulations governing the transportation of hazardous materials The use uf this column is an optional method for identifying hazardous matenels on Bills of Lading per 172.201(a)(1) of Title 49 Code of federal Regulations Also when shipping hazardous materials, the shipper's certification statement pressnbed in section 172204(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 fora particular material SHIPPER PER Iles is to certify that the above named inatenals ore properly classified, packaged, marked, and labeled, and are in proper condition for transportation according to the applicable regulations ol uict U.S Department of Transportation. Carrier acknowledges receipt of packages and any required placards. Carrier certifies emergency resporice (Morriss- tion was made available and/or carrier has the U.S. Department of Transportation emergency response guidetioth or equivalent documentation in the vehicle. Property described above is received in good order, weer* as noted The format and content of hazardous item list is the responsibility of individual corn- 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 Material Table) and Sections 172.202 and 172,203. Proper shipping name, hazardous class, UN identification number, packing group. Note: Liability limitation for loss or damage in this shipment may be applicable. See 49 United States Code, Sections 14706(c (11(4) and (B). Date L , (Ndme of Carrier) OF LADING - SHORT FORM or hazardaus_materials must enter 24-hour emergency ,one number under 'Emergency Response Phone Number. order Bill Lading No Shipper No Carrier No and subsidary class(es). CARRIER PER c , -j Vi i i / 1,-)