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1 i!la lYIfCIVlUtI�H1V11UIVl
<br /> is an acknowledgement that a bill a1 lading ham been lasued and Is not the original BIII of Lading,not _ Shippers No.
<br /> a copy or duplicate,covering the property named hereln,and Is Intended solely for filing or record.
<br /> Carrier's No.
<br /> CARRIER:," ; amir.f f ._ SCAC Date f
<br /> TO: ti FROM:
<br /> Shipper i CYS
<br /> Street:;: e0 ;'-jt,+sr Street
<br /> Destination '.{};j�;ij �' ZipOrigin. �. 4 1,! �V ;;'',' ' '� Zip
<br /> Route: Vellicie;Number U.S. DOT Hazmat Reg. No.
<br /> Number of • ..
<br /> Shipping Description . - and exceptions (subject to
<br /> Units HM correctioril RATE
<br /> .__......... ......... .._.._._ _. .._......,,..._.-._._.._..................._....................._.,...,._. ,..,,...._..... ,.._ ..........
<br /> �... �.._....... _ . ....,.,,,..,,..... .... __...Y,_..._ .....................................,..,,_.._...-. ........_.._..,.,..,........_ _............ _ _..,- - - —
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<br /> �_.. .....- �..,_:f�!., , .t.... ...............:.............. .�f....�r... .�r ... ._.�j y.,..,,... ..._................ ...........
<br /> ...- ,._. .�..._
<br /> _....... ... .... ......_..--..........,.,..�—.......... __.-. .... ..
<br /> - ....__._..................._.....,.... ...j.. I_.-...__t..._.. ........, ,..-.._--......_.... _ ..T ...._..--__- .. -....._ __ ..._.......�....... .-..__-
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<br /> .............................. ....................r..... �. L -Y r .. ., .._.
<br /> ...-_....--_- ... ....... ....._......._........_....._._._......
<br /> ..... ................ .......................... ... -..,............._.....-. ..-...
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<br /> e
<br /> Remit C.O.D. to: CODC. O. D. FEE: TOTAL CHARGES:
<br /> Address: prepaid❑ `
<br /> City: State: Zip: AMT: $ Collect 0$ $
<br /> 11 the shipment moves between two parts by a carrier by water,the law requires That the Subject to Section 7 of condition If this shipment is to be delivered to the consignee wilhaut
<br /> bill of lading shall stale whether it Is'Carders or shipper's weight'. reocufse an the consignor.the consignor shall sign the following statement FREIGHT CHARGES
<br /> Note.-where the rate is dependent on value,shippers are required to state specifically in The carrier shall not make delivery of this shipment wilhouk payment of freight and all other lawful FREIGHT PREPAID
<br /> writing the agreed or declared value of the property. charges. Except when CHECK BOX
<br /> The agreed or declared value of the property Is hereby specifically stated by the shipper box at right [:]ti charges are
<br /> to be not exceedingper_ (Signature o1 Consignor) (a checked to be coiled
<br /> RECEIVED,subject to the classifications and tariffs in effect an the date of this BIII of Lading,the properly described above In apparent good order,except as noted(contents and concildon of cardents of packages unknown),
<br /> marked,consigned,and destined as Indicated above,which said company(the word company being understood throughout this contract as meaning any poison or corporation In possession of the property urkder the
<br /> contract)agrees to carry to its usual place of delivery at said desllnallon.If on its own read or its own water line,otherwise to deliver to another carder on the mute to said destination,It is mutually agreed,as to each carder of
<br /> all or any of said property over all or any portion of said route to destination,and as to each party at any time Interested In all or any said property,that every service to be performed hereunder shall be subject to all the
<br /> conditions not prohibited by law,whether printed or written,herein contained(as specified In Appendix B to Part 1635)which are hereby agree&to by the shipper and accepted ter himself and his assigns.
<br /> This is to certify that the above-named materials are properly classified,described,packaged,marked and labeled and
<br /> :: re In proper conditlon for trans ortatjon accordingto thea ilcable re ulaifons of the Department of Trans ortation. PER:
<br /> afIPPER: C: i` 'y'~ 1 CARRIER: 1 k– .`i �'(i/`� ry "T
<br /> PER: �1 f ifDATE: f J ' PER: IS DATE: l- 'e) -
<br /> EMERGENCY
<br /> 's) -EMERGENCY RESPONSE: MONITORED AT ALL TIMES THE HA7AADOUS MATERIALS IS IN TRANSPORTATION,
<br /> TELEPHONE NUMBER: ( l INCLUDING STORAGE INCIDENTAL TO TRANSPORTATION(172.604).
<br /> -
<br /> 30-BLS-C3
<br /> (HEV.9195)
<br />
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