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- ORIGINAL—NOT NEGOTIABLE
<br /> 1 ��,�,, Carrier No.
<br /> Page� of t IC-A, �� N 5 eO T z Date
<br /> {Name of carrier) �-- -- -
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<br /> On Caiecl an 0e41 SnIlNl r4a.In. eppaer baf"conatgnae'n name or as adoldwaa Prcoidad rn 11em 431 Set 1.
<br /> TOC FROM:
<br /> Shipper
<br /> CORSiQM3e —
<br /> Street Z43_, L I�iLLr+,ut+s 31"'
<br /> Streetr�fS?s 1�'[— City InYaS
<br /> //LrTY! State (;(4- ZIP Code t
<br /> City State Zip Cod�f `�
<br /> 24 hr.Emergency Contact Tel.No, 2
<br /> Route Vehicle
<br /> Nwrlser
<br /> Na.oI Units HM BASIC DESCRIPTION TOTAL QUANTITY WEIGHT CHARGE
<br /> S Container Type UN or NA Number,Proper Shipping Name,Hazard Class,Packing Group (M•niphl,Valume, (SUtyect 10 RATE
<br /> r� Gallons,etc.l C6rernon)CID ,p
<br /> g�'e luislu4 V4� �t 14t✓ 47r . ! 'L k
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<br /> NO V 2 0 _
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<br /> DFF�RTj HE`1LTy �pA�T
<br /> PLACARDS TENDERI~D; YES L= NO o REMIT
<br /> Novo+ri.A r.'-n.1=:s depandwrt an vague,sdPlaere era raquGed a"I'd I hantrydxd:ala d,at los conlenk ar dda C.O.D.7Q;
<br /> n4 erpead or declared ralua of the PmPa4ry,as tplrpwa."ryaADDRESS
<br /> agnw a darJupd vawa ar meProperty I-hereby syec�:-aAi Nissan by a-ahpper a e a
<br /> ant are July and acc"huty
<br /> ba ar aacaadnp par daperibpd adava by the prop■r eMPping C.Q.D.FEE:
<br /> I?i Wnere I�appacabb teal!ppeiaWns name and are classgtwd, packagad,
<br /> apa..lPy a lanincyin o[aha damars Itppe'ry ebaen marked end wbaeem'Agtanrdad,and era d ARIL: $ PREPAID O
<br /> a le'eaae or a value dacyradpn br ala era Pyar and Iro ahlpb.,does nm rabnso COLLECT 0 s,
<br /> ma raxnara urtHiry dr deters a redeye,lh0 Ganey..24 ehaA Whdd to the"d-1 In a6 w ih, In prepay cor,dilid' for - - -
<br /> ArInnined M duh 13mm ane.Bae NMI hand 172 1 Slgpon edcwd ng w applicable 5:4]eet M 6 7 0l ale eonafaaa.Y b b a dWW In Aa TOTAL.
<br /> -nleddawoI and ners.nal 9werNne'Nal rA€bout • poor,me eenag n4N shell.19.,Ina
<br /> t31 Cgmmodrdps nllylAnng aparxal ar edTitganal can da eaarAian h han9ing v,a{awrg a aliens g I�;nrasp.uwam.x: 9CHARGES S
<br /> must bs sa marked antl padugaC as to amus dela nanspadalbn.5w Seaton 210)a! r Qu ,,The malar anon nal mato Musty d In lFr,a•,r r.4hou!Inca—or FriEiGHT GiAR{3E8
<br /> cam 3e0,64is or Lflagirq.Fxelghl 61As and Sls!omada or Ch.,ges and Sactian 74x1 d Inighl end ca(11e 49 cherg s.
<br /> FPYEtlaaIT PRePA,1D CMCa hs.'.r chargac
<br /> !os. trach cane dna Gandidw,o iw a enter 6Uch arg;bs. tiigrl�dr2 tea- aaoepl M—ao*r era rr w
<br /> d" pdxaaa 0 rne-<r
<br /> RµFIV-eD,auti ed w Ire-ra"Milans and 11I In~or It.das dl 1.Issue at d,d$ia d Ladetg, linalian and as t6 6edn Pens'al Irma NlaroS{ad W ea or a padgr[y,ria!Query servgn to
<br /> dad pr."daurbw abere�er nI goad order,encept as.nobd(Comar is and evndhwr,d cern any laid
<br /> an
<br /> CI geP2ga:un Krwn N,erd.icea,-reigned,and deadaed aF Ind'ealpd eUora wRxh said Nn It 6s.yodam.d netiyader etlad N S,IAWeI w all lha Aryl at+edEdg reams and Wdale4al6,n Y,e gavem n9 dsaF
<br /> i)he word w rwr t>rmg nndararaad ylrC4Fout lhi cndIwl 05 mein rporanan m sNcaty.oI dela o1 child 1.
<br /> PaaifAepn 64 du Ina any :,I d IX ca Slapper nan�y mmkq the!ha to Paddler wah all rhe lad Mtn1a and wndAiwrs u;Ina,
<br /> Pa.o lir 5alder fns Cod 11 agnas tams mw ino roul t to hard c det ery al gatT dasJ Puve,ning tya9eihdatlan and dap said harms.and o3ndi ddr,are hanaby 1gaad to by no Wppgr end
<br /> teddy,4 m his xodro.odrdnea 1p diver b e+q^.he me rpWa to aaltl desG,alivn.a a mule aataPted tar hlmaeN and hC aaaf
<br /> ally spread n Ip each G1fie,al re or any C.cad rmpany ave'8'11],any ponhon el aavr earl.b dee- Spa,
<br /> SHIPPER C7Z ��� CARRIER
<br /> PER
<br /> PER �tc.� " 4
<br /> _.
<br /> DATE � � i�-
<br /> Permanent post-officeaacyrass of s#;ippar. STYLE F275-3 02012LHaEi_T'IASTEIt® (aoof E21-saos vww,VabwddQdhI-corn
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