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�111� fl111� {1A ® ® p p � ® 1 BflB Is an eoknowledgementthat abill oflading hasbeen Issued and Isnot the Original Bill oflading, not acopy 11-7711 IU� EM C�$AN UM or duplicate, covering the property named hereto, and is Intended solely for Ming or record. Shipper's No. ' tF e .,.�L . . , x 'c,_' ar :.`. : Carrier °' _ ' - `'' SCAC Carrier's No . RECEIVED, subject to individually determined rates or contracts that have been agreed upon in writing between the carrier and shipper, if applicable, otherwise to the rates, classifications and rules that have been established by the carrier and are available to the shipper, on request; and all applicable slate and federal regulations; 1� of �; at date from the Property described below, in apparent good order, except as noted (contents and condition of contents of packages unknown), marked, consigned, and destined as indicated below, 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, if 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 contained, including the conditions on the back hereof, which are hereby agreed to by the shipper and accepted for himself and his assigns, TO : FROM 1 - _ a to Consignee w � . Er L_. ._ _. ;� � Shipper . Street -. s '_ r . ; _ Street ? t ck, > `s is :` a ': Origin f� 1 P r t Destination Zi Ori in f" f Zi Route Delivering Carrier Vehicle Number U . S . DOT Hazmat Reg. No. M 11=1 MINE • � � �� r �3 .- .Ft-i E.? s ., .•b`�: ..-ems �ta � E. ... ..,� "�s ``� ( . _,;; _ fr� f -,•-.- `�f f Ili' 41 Subject to Section 7 or conditions, if this Aw&Remit COD too shipment Is to be delivered t 'A.rO® FEE � o the consignee AMT . ' .r A�.I ,.1 or without recourse on the Consignor, theUOD ❑ ddress: consignshall sign the foaowingstatement: Prepaid The carder shag not make delivery of this City: State: Zi p ,/ ' p : shipment without payment of freight and all Collect El . other iavlul 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 slated by the shipper to be not exceeding S Per (signature or consinnor) $ ❑ Prepaid ❑ ColleCt NOTE: Liability Umitatlon for loss or damage in this shipment may be applicable. See 49 U.S.C. g 14706 c (1)(A) and (8), g BY SHIPPER BY CARRIER This is to certify that the above-named materials are property classified, described, packaged, marked 9 and labeled, and are In proper condition for iransponation according to the applicable regulations of 0 ® IDVER'Sthe Department of Transpodatiun. Per NATURE: - r �}} r L SHIPPER : Y i 't ;. t . ; t :' _. . ; +. L , _ --_6 y CARRIER: r :� ., _ k � . : t �. . : , ..< - t ) .. , _ PER: DATE: PER: - ;._ — DATE: -t EMERGENCY RESPONSE NAME OR CONTRACT NUMBER TELEPHONE NUMBER * ; OR OTHER UNIQUE IDENTIFIER. r ' j 969 (Rev_ 3/17)