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This Memorandum is an acknowledgment that a Bill of Lading has been issued and is not Original Shipper No. Bill of Lading,nor a copy or duplicate,covering the property named herein,and is intended solely for filing or record. D31 Carrier No. Ad%encBd Chemicai Transport Inc,IDBA ACTex'1*0 Page of Date �� 1 (Name of carrier) (SCAC) On Collect on Delivery shipments,the letters"COD"must appear before consignee's name oras otherwise provided in Item 43q Sect, FROM: TO: Shipper Thatcher Com pony Of C'.aiilibmia Consignee r"d. anced Qhery c aS Treatment Street 1010 Industrial Dries= Street 6133 Edith Bhd Nir CityOC #ar State ,jZip Code r=H-;;k city ti b ►tarn ue State NM zip Code � � 24 hr.Emergency Contact Tel.No. Route Vehicle Number No.of Units BASIC DESCRIPTION TOTAL QUANTITY WEIGHT CHARGES &Container Type UN or NA Number,Proper Shipping Name,Hazard Class,Packing Group (W®I Galht,lons, Volume, (Subject n) RATE (UseFor Only)Gallons,etc.) Correction) Use Only) 1)t.th11550, Asrasofs, 2.'1, 1Jnis mai Waste(ACS) r PLACARDS TENDERED: YES p NO p REMIT C.O.D,TO: Note—(1)Where the rate is dependent on value,shippers are required to state I hereby declare that the contents of this ADDRESS specifically in writing the agreed or declared value of the property,as follows:"The consignment are fully and accurately agreed or declared value of the property is hereby specifically stated by the shipper to described above by the proper shipping C.O.D.FEE: be not exceeding per name and are classified, packaged, COD Amt: $ PREPAID ❑ (2)Where the applicable tariff provisions specify a limitation of the carrier's liability absent marked and labelled/placarded,and are - a release or a value declaration by the shipper and the shipper does not release in all respects in proper condition for COLLECT ❑ $ the carriers liability or declare a value,the carrier's liability shall be limited to the extent transport according to applicable Subject to Section 7 of the conditions,if this shipment into be delivered to the TOTAL provided by such provisions.See NMFC Item 172. international and national governmental consignee without recourse on the consignor;the consignor shall sign the CHARGES $ (3)Commodities requiring special or additional care or attention in handling or stowing regulations. following statement: must be so marked and packaged as to ensure safe transportation.See Section 2 e of g the carrier shall not make delivery o4 this shipment without payment of FREIGHT CHARGES P 9 P () freight and all other lawful charges. Item 360,Bills Of Lading,Freight Bills and Statements of Charges and Section 1(a)Of FREIGHT PREPAID Check box It charges the Contract Terms and Conditions for a list of such articles. nature Si except when box at are to be Signature (Signature of Consignor) right is checked ❑ collect 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 carrier 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 carrier of all or any of,said property over all or any portion of said route to des- SHIPPER CARRIER Adilenced Chemical Transport IncJDBA AGTaWfe PER "t PERll�-. 4� L '7 `~ a DATE ► 1 '^r 3 Permanent post-office address of shipper. �' STYLE CF375-4 ©2012 LABELf`%ASTER0 (800)621-5808 www.labelmaster.com ®P uswc soreenn..v,c a�i 80ytNQ