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This Memorandum is an acknowledgment tnat a bill of Laomg nas been issued ana Is not Urlgmal Shipper No. zs Bill of Lading,nor a copy or duplicate,covering the property named herein,and is intended solely for fillr record. Carrier No. Page of ® S � �. ps (Name of carrier) (SCAC) Date A- Z —0 On Collect on Delivery shipments,the letters"COD°must appear before consignee's name or as otherwise provided in Item 430,Sec.1, FROM: ) Shipper j�$ /1if il� Qe4 . �Q1S, Street Aw Street city StateOM Zip Code 9 j' City o e yo s p` State Zip Code .-Q7 24-hr.Emergency Contact Tel.No. � Vehicle Route Number BASIC DESCRIPTION TOTAL QUANTITY WEIGHT CHARGES No.of Units Proper Shipping Name,Hazard Class or UN or NA Number,Proper Shipping Name, (Weight, Volume, (Subject to RATE (For Carrier &Container Type yr/UN or NA Number,Packing Group n p Hazard Class, Packing Group Gallons,etc.) Correction) Use Only) i F/ tS[ 1 7 ; e PLACARDS TENDERED: YES ® NO 17-1 REMIT I hereby declare that the contents of this C.O.D.TO: (1)Where the rate is dependent on value,shippers are required to state Y ADDRESS in writing the agreed or declared value of the property,as follows:'rhe consignment are fully and accurately eclared value of the property is hereby specifically stated by the shipper to described above by the proper shipping C.O.D.FEE: acting per .' name and are classified, packaged, COD Amt: $ PREPAID ❑ '(2) m the applicable tariff provisions specify a limitation of the carrier's liability absent marked and labelled/placarded,and are COLLECT ❑ $ a 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 carders liability shall be limited to the extent transport according to applicable Subject to Section 7 of the conditions H this shipment Is to be delivered to the TOTAL rovided b such rovisions.See NMFC Item 172. International and national governmental consignee without.recourse on the consignor,the consignor shall sign the CHARGES $ P Y P following statement (3)Commodities requiring special or additional rare or attention in handling or stowing regulations. The carrier shall not make delivery of this shipment without payment of FREIGHT CHARGES must be so marked and packaged as to ensure safe transportation.See Section 2(e)of freight and all other lawful charges. FREIGHTPREPAID Check box if charges item 360,Bilis of Lading,Freight Bills and Statements of Charges and Section 1(a)ofexcept when box at are to be the Contract Terms and Conditions for a list of such articles. Signature (Signature of consignor) right s checked ❑ colied RECEIVED,subject to the classifications and tariffs in effect on the date of the issue of this Bill of Lading, tination and as to each party at any time interested in all or any said property,that every service to be the property described above In apparent good order,except as noted(contents and condition of con- performed hereunder shall be subject to all the bill of lading terms and conditions in the governing clas- tents of packages unknown),marked,consigned,and destined as indicated above which said carder sification on the date of shipment. (the word carrier being understood throughout this contract as meaning any person or corporation in Shipper hereby certifies that he is familiar with all the lading terms and conditions in the possession of the property under the contract)agrees to carry to Its usual place of delivery at said desti- governing classification and the said terms and conditions are hereby agreed to by the shipper and nation,if on Its route,otherwise to deliver to another carrier on the route to said destination.It is mutu- accepted for himself and his assigns. ' ally agreed as to each carder of all or any of,said property over all or any portion of said route to des- SHIPPER ) CARRIER PER PER DATE �� ;? Permanent post-office address of shipper. �,CLEeP � STYLE F360-4 ©2003 LABELMASTER®(800)621-5808 www.labelmaster.com �'"s�s"N"xayse SOV INK„