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it iii oe 111"r IIYti vngj"n Carbon,and retained by the Agent. <br /> Shipper's No. <br /> Carrier °=rfr10f--�i ENGs��k�°�f :€i�"��`tire: �Ft� �ti SCAC Carrier's No. <br /> 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 rules that have been <br /> established by the carrier and are available to the shipper•on request;and all applicable slate and federal regulations; <br /> at date from k , �( (1 1),i I•��i'% �'- � <br /> the Property described below,in apparent good order,except as noted(contents and condition of contents of packages unknown),marked,consigned,and destined as indicated below,which said company <br /> (the word company being understood 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 <br /> route,or otherwise to deliver to another carrier on the route to 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 <br /> each party at 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 <br /> contained,including the conditions on the back hereof,which are hereby agreed to by the shipper and accepted for himself and his assigns. <br /> TO: FROM: <br /> Consignee Sty S`KY Ft`TE- y'SE Shipper <br /> >t, <br /> Street X O i Vr pS f C HAf NEL On-l V,-c Street 1 t <br /> Destination 4 Y g Zi 2451 <br /> mmc4;", Origin ' t y " Zi <br /> Route <br /> Delivering Carrier Vehicle Number U.S. DOT Hazmat Reg.No. <br /> • � (p ` pp �^��g gy p �^; y �y^ {� �y/• @,;)fid <br /> j t - 6,1UPIA l��J�'�. id+�'@.C',I NS- S,CPS D iL FIL S E IS 6si.��A NIA �—wry P 4 t�'JA <br /> ER-CONT <br /> Remit COD to: Subject to Se lion 7 of condbions,If(his COD FEE: <br /> shipment is to bedebveto to the consignee COD <br /> AMT. <br /> without recourse on the consignor, the <br /> Address: consignor shall sign the following statement Prepaid ❑ <br /> The terrier shall not make delivery of this <br /> City: State: Zi shipment without payment of freight and ell d` <br /> otherlawfui charges. collect El$ <br /> NOTE:Where the rate is dependent on value,shippers are required to state specifically in writing TOTAL CHARGES: FREIGHT CHARGES: <br /> (he agreed or declared value of the property.The agreed or declared value of the property is <br /> hereby specifically stated by the shipper to be not exceeding $ Per (Signature of Consignor) ❑Prepaid ❑Collect <br /> NOTE:LlabfHly Llmitation for loss or damage in this shipment may be applicable.See 49 U.S.C, i ' 1 wit!I id ' <br /> 14706 c 1 A and S. a BY SHIPPER BY CARRIER <br /> This is to certify that the above-named materials are properly classified,described,packaged,marked MW <br /> and labeled,and are in proper condition for transportation according to the applicable regulations of DRIVER'S <br /> the Department of Transportation,Per SIGNATURE: <br /> t, / CARRIER-1 <br /> SHIPPER; <br /> PER: •- DATE: PER: �`�' .�` t i' �?lid - DATE.. <br /> /. <br /> EMERGENCY RESPONSE NAME OR CONTRACT VUMBER <br /> " 3d'I�� art <br /> TELEPHONE NUMBER: �� s � �� OR OTHER UNIQUE IDENTIFIER: <br /> r, ✓ Y „„,. ..,.<.„,v- <br /> 969(Rev.3/17) <br /> Agent must detach and retain(his Shipping Order and must sign the Original Bili of Lading, <br />