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STRAIGHT BILL OF LADING -SHOORT FORM-Original-Not Negotiable <br /> S,,W.,er's No. <br /> -- U wG <br /> (Carrier) SCAC. Carrier'sNo. <br /> T <br /> Received,subject to the classifications and tariffs in effect an the date of this Bill of Lading: <br /> at date .. from <br /> It»properly 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 Me word company being understood throughout tins <br /> convan es meaning any person or cmpwatien in possession of the property under the ca=O agrees m carry to its usual place of dallvery at said dostmation,if on its own road or hs own water line,otherwise to deliver a another center o the mute u said <br /> destination.a is muNally agreed,as to each canter o}all or any of said property war an or any portion of sad route to desllnetian,and as to each parry at any time interested in all or any of said praperry,that every service W 4e peRormetl hereunder shall be <br /> subjeM to all the corxfitlona net prohibited 4law.whelhcr pdnted or written,herein corxelned(as s ecilied in Appendix 8 to Part 1035)which are hereby agreed to by the shipper and ad apted for hfmseif and his assigns. <br /> (Mail or street address of consignee for purposes of notification only.) 1 ,��`_ { ! . _j_ <br /> TO: �S FROM: V �[.I� W.vrf�ir�'� (� <br /> Consignee 8,705 � A Shipper <br /> Street Street L.-t £ 72d" <br /> Destination 7 OYZI Zip dj' 4 <br /> �'�Os' Origin Zip 4j�L"7,'Z.. <br /> Route: J <br /> Delivering Carrier Trailer Initial/ U.&DOT Hazntat <br /> Number Rag.Number <br /> No'of Hazard F.D. Packing C� I Check <br /> packages HM Description of • . <br /> F 2 owu, <br /> (Wit) t-le-)NJ O�v <br /> l_ qj <br /> Ste►- Rc.� � CN +��...w) -- - v'1.0 p <br /> Remit C.O.D. to: Subiect[t 9e den 7 at conditlons,if'hi' <br /> C. 0. D. FEE: <br /> COD AMT: shipment a to be don the to the consignee <br /> Address: H without recourse on the consignor,the <br /> consignor shall sign the rollowing statement: Prepaid ❑ <br /> City: S#ate: Zip: The tamer shall not make delivery of this ❑ <br /> shipment without payment of freight and all Collect <br /> 'If"stdpnert mores betm an Iwo pwh by a timer by walar,Ne taw requires That Ila b9 of lading shall state whether a atamets or shipper's weight. other lawful charges. <br /> Date.-where 0"rate adape�antenvalue,shipparaa,aregdredtostatesp�ca,lyinwrilingtheagreedordadarrad"kmofItsproperty. Charges Advanced FREIGHT CHARGES <br /> The agreed or declared value of the popenty is hereby <br /> specdk*stated by the shipper to be nal erceedig pe+ $ (Stgnatura of consigner) ❑Prepaid <br /> ❑Collect <br /> rhos Is to cedeY that m•eheve rurnetl met•dali an propedy cusadied,d•acrlb•d,PeckageQ marked aria LJ <br /> weeled ens er•m nma•r oorweion for rreeeportedan•acgrdlrp ro IM eppliaeule regoleLona of the oepanment YES NO-FURNISHED 6Y CARRIER <br /> of rra vvortadcn. _ <br /> Per DRIVER'S SIGNATURE: <br /> SHIPP r CARRIER: <br /> PER: BATE: 47 PER: DATE: <br /> EMERGENCY RESPONSE <br /> TELEPHONE NUMBER: 7� <br /> Permanent post office address of shipper Monitored at all times the Hazardous Material is in transportation Including storage incidental to transportation(§172.684) <br /> 9-BLS-A4(Rev.7/95) <br /> C� <br />