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This Memorandum is an acknowledgment that a Bill of Lading has been issued and Is not Original Shipper No. Bill of Lading,nor a copy or duplicate,covering the property named herein,and is intended solely for filing or record. Carrier No. Adyitim, e'er r-hemlc;al Tim, nFoDert Inc../DBA ACTENVIR0 Page T of 4 Date (Name of carrier) (SCAC) On Collett on Delivery shipments,the letters'COD•must appear before conaigme's name oras othe,wise provided In Item 430,Sec.1. FROM: TO: Shipper JOHN NEIL STEVENS/M SIMPSON CC I Consignee ..,,_r..-.� .,.. ...._ •_ _a�...e ..-„ �- , Street A!1`Jt6 411 =ti �a O�r Street ; Yry►r��!u, [a„R.d Crit y.r��,�,j- t state I•ikZip Code City, _,p - r State t,A Zip Code Aa v�� . . .p 24 hr.Emergency Contact Tei.No. _ Route Vehicle Number No.of Units u BASIC DESCRIPTION TOTAL QUANTITY WEIGHT CHARGES t:Container Type H UN or NA Number,Proper Shipping Name,Hazard Class,Packing Group (Weight Volume, (Subject RATE (For Carrier l y Gallons,etc.) Collectionn)) Use Only) r , A,- .Ist r\Lk.. PLACARDS TENDERED:YES o NO a REMIT C.O.D.TO: Note—(1)where the rate is dependent on value,shippers are regried to state I hereby declare that the contents or this ADDRESS specibcely in writing the agreed or declared value of the property,at follows:'rte consignment are fully and accurately agreed or declared value of the property is hereby specifically stabil by the shipper to descried above by the proper shipping C.O.D.FEE: end D per name and are classified, packaged. COD PREPAID 11(2)where Me applicable tariff provneans specily a emltauon d de ranters labliq absent marked and IabeaedlplacaNetl,and are Amt' $ COLLECT ❑ $ e release or a value declaration by the shipper and the shipper does not release In all respects In proper condition for the carrier's liability or declare a value,the camers liability shall be lmi ed to the extent transport according to applicable Sblecr to Section 7 of the conditions.a las shipment is to be dNherw b tti TOTAL provided by such provisions.See NMFC Item 172, international and rational gwemmenW eensiq..without —..*on the corslaer,the consignor shall sign the CHARGES $ (3)Commodities requiring special or additlonad care or alenibn in handing or stowing regulations. bluwng aetwnent must be so marked and packaged as b ertsum safe transportation.See section 2(a)d The Tamer the, rot make delivery or live shprnant without payment d FREIGHT CHARGES item 360,Bills d Lading.Freight Bilk and Statements d C () - height and all other lawful charges. � i9h herpes and Sectlon 1(aJ d FREIGFir PREPAID Check bmcs the Contract Terms and Conditions for a lat d such articlk. Signature iska dts.d car-0-1dgtit as�p ❑ �cai d RECEIVED,stbiect bite classifications and tariffs In#pact on tle dale of the issue d this BE of Lading, Wmtion and m to each party at any tine kaerested In all w any said property.that every servlce to be he property desvilbW above in apparent tents packages u known), conn�gied,and destied as nticated above which said cacept as noted(cohienI5 and condition of mrder s an perIonned the shall of shb ant Oxo 68 d L7dsg kms xd cat6tiora n fie govemng das- (tte word carrier being undwstood throughout this contact as meaning any person w mpor2hon it Shipper hereby certirras that he is farniffar with as the lading tomo and conditions in the possession d the property under the meracl)agreas to carry to its rswl place of delivery at said dae6- govemlrg classlleatim and the said terms and cond6lons are hereby agreed to by the ahipper and nation,if on its route.otlsmise to deliver to another carrier on the roue to said destitatiuc It is mrLr accepted for himself and lis assigns. aly agreed as to each carrier of ae or any of,said property mer all or any portion of said route to des- SHIPPER JOHN NEIL S?EVENSOH SIMP.``ON C0 CARRIER Advanced Cttertkal Transport Ine.JD13A PER PER { ,:.jJ r . DATE Permanent post-office address of shipper. STYLE CF375-4 02012 LABELMASTERO (800)621-5808 www.labolmaster.com •• me_