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THIS MEMORANDUM is an acknawledgemart that a bill of lading has been issued and is not the original 13111 of Lading,not a copy Shipper's No. Y,f� of duplicate,covering the property named herein,and Is intended solely for filing or record, Carrier's No. f Carrier r k. I' t N y� `.J It l t � SCAC Date TO: FROM: Consignee NU s Iilni-t fur-1`16 L"SL1 Shipper Ou S09Y- . LWuXoi, Street Cf.0 -, AJ PA 6LO ^ V Street �LE 1 NJC Destination --I Zi LIS Origin A Zip Route 1 Vehicle Number U.S.DOT Hazmat Reg No. r Number Description of Articles 1q 13 hi 62 Remit COD to: &uh7ed o Section r 0l conditions,1f this /� COD FEE: shipm5nt is l0 hs delivered fo the consignee COD AMT. wish out recourse on the consignor. the , Address: consignor shall sign the fell statement Prepaid ❑ l �••yy The carrier shall not make delivery of this p City: State: Lip: shipment withoul payment of freight and all J) Collect ❑ other lawful charges, NOTE:Where the rate is dependent on value,shippers are required to state specifically In writing TOTAL CHARGES: FREIGHT CHARGES' the agreed or declared value of the property.The agreed or declared value of the property is hereby specifically stated by the shipper to be not exceeding $ Per (signature of consignor) $ ❑ Pfopald ❑Collect RECEIVED,subject to individuaily determined rates or contracts that have been agreed upon In writing between the carrier and shipper,if applicable,otherwise to the rates,classifications and rulas that have been established by the carrier and are available to the shipper,on request!and at;applicable state and federal regulations;the Property described above,in apparent good order,except as noted{contents and condition of contents of known), packages un marked,consigned,and destined as indicated above,which said company(the word company being understood throughout this contract as meaning any person or corporation in possession of the property under the contract)agrees to carry to delivery at said destination,it on its route,or otherwise to deliver to another carrier on the route to said destination.It is mutually agreed as to each carrier of 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 of said Property that every service to be performed hereunder shall be subject to all the conditions not prohibited by law,whether printed or written,herein centained, indudin the conditions ortthe back hereof,which are here a reed to b the shi er antl acce ted for himself and his assigns. NOTE:Liabillty Lim€ts Ion for loss or damage In this shipment may be applicable.See 49 U.S.C. 14746 c 1 A and(B).' .. By SHIPPER�BY CARRIER his Tis to certify that the abeva-named rnatarlals are properly classified,described,packaged,marked and labeled,and are in prepar condition for transportation according to the applicable regulations of UN `1{� DRIVER'S - the I7epartrl of Transportation. Per SIGNATURE: SHIPPER: CARRIER: r PER: DATE: i, i PER: DATE: EMERGENCY RESPONSE NAME OR CONTRACT NUMBER TELEPHONE NUMBER: OR OTHER UNIQUE IDENTIFIER: 209-BLC-Q 3 12461 (Rev.9110)