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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. 0202013 Admmed Cihen k:al Tr--1I k'r:,/DBA ACTENVIRO Page of Date (� (Name of carder) (SCAC) On Collect on Delivery shipments,the letters'COD*mwt appear before consignee's name or as otherwise prodded In Item 4W,Sec.1. I FROM: TO: Shipper is lEt�9�'viFYli�F Atfi 1�} R1AiPfflAJ f`(1 Consignee, _+ _a .. uo +w ie t.z=..,a+;rwas ses.aaaaeat It Street � ► � AVE, Street `+33 F-dif it ++1"$:E City —..r u w State Zip Code City State Zip Code ' w'N v:' 24 hr.Emergency Contact Tel.No. Route Vehicle Number No.of UnitsH M BASIC DESCRIPTION TOTAL QUANTITY WEIGHT CHARGES 8 Container Type UN or NA Number,Proper Shipping Name,Hazard Class,Packing Group (weight,Volume, (Subject to RATE (For Carder rGallons,etc.) Correction) Use Only) VF13st•Afirers k, ° . �F#c h not es"Wft 1L>G"W ) t f PLACARDS TENDERED: YES O NO E=I REMIT C.O.D.TO: Note—(1)Where the rate is dependent on value,shippers are required to state I hereby declare that the cements of this "ADDRESS spedlice0y in writing the agreed or declared value of the property,as fdlawc'The consignment are fully and accurately agreed or declared value of the property is hereby specific* scaled by the shipper to described above by the proper shipping be"°r'-"e°d"'y Ler name and are classified, packaged, CbQ C.O.D.FEE- (2)Where the applicable tariff provisions specify a limitation of the carvers lability absent marked and labelled(placarded,and are Amt: $ PREPAID ❑ e release or a value declaration b the shipper pp COLLECT ❑ $ y pper entl the shipper does not release In eA respects In proper condition for - the carriers lability or declare a value,the carriers liability shall be limited to the colon+ transport according to applicable Subject to Section 7 01 bre coridAbru,N Ihla.Mipinent Is to be delivered w the TOTAL provided by such provisions.See NMFC Item 172. international and national g—mmental o ignee without mcau on`the..canslynur,the consignor shall sign the CHARGES (3)Commodities requiring special or additional care or allenlion in handling or stowing regulatiervs. Idbw n statement $ must be se marked and packaged as to ensure safe transportation.See Section 2(e)d The canter harshall lawful char dslvery d 1QIa shipment without payment of FREIGHT CHARGES Ireblrt entl.aA-amen tewlul charges. _,.�+ FREIGI��ti P i1D Check box�dhrgas Item 360,Bills of Lading,Freight&IIs and Statements of Charges end Becton 1(a)d _ the Contract Terms and ConAtlons for a list d such elides. Signature (��s d ) _ detltm ❑ cvnle l RECEIVED,stbiect to the classifications and tariffs in effect on the date of the issue of this Bill of Lacing, tnatkn and as to each platy at any time Interested in all or arty said property,that every service Io be ,he property roperty ell above in apparent good order,except as noted(contents and condtion d con- performed hereunder shall be subject b al the bill of lacing temp and cencill n the govenwg rias mts packages unknown),marked consigned,and destined as indicated above which said carrier sli ation on the date of shipment. (the word owner being understood throughout this contract as meaning any person or corporation in Shipper hereby certifies that he Is famlaar with all the lading terms and conditions In the possession d the property under the conhad)agrees to carry to Its usual place of delivery at said destl- governing classification and the said terms and conditions are heretry agreed to by the shipper and nation,t on its meta,otwwise b dQW9r to anode(mmer on to route to said destination.It is mute- accepted for himself and tisassigns. ally agreed as b each canner d all or any d,said property over all or any porton d said route to des- SHIPPER IMIN NEIL &MVENSIM 60APSON Go CARRIER ;,toad � tMX--Oft k./E $A PER _.. �,^ _. , :i PER DATE Permanent post-office address of shipper. '°`�" —�riNK- STYLECF375-4 02012 LABELMAS-f ER® (800)621-5808 www.labelmaster.com