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This Memorandum is Len acKnowleagmen mat a Dlil 01 La01ng nas oeen Issueo anG Is not unglnal Bill of Lading,nor a copy or duplicate,covering the property named herein,and is Shipper No. intended solely for filing or record_ Carrier No. ADVANCED CHENRCAL TRANSPORT, INC, r Page of Date till rill (Name of carrier) (SCAC) Dr. .-I on Delivery shipments,the Ietmrs'GOD"must appear before conelgnal name or as otherwise provided in Item 43C.sect. FROM: W rAesa U nthed f Doll Dishict ffiali Ulfhm Koo TO: maqleca.[W*d&: DW*.1l f—t Shipper Consignee €� M-Orl-MDZr ` L 3.lits''Ave Street rt Street City State �.pZiip Code Mantel City State Zip Code 24 hr.Emergency Contact Tel.No. Route Vehicle Nurnbe- No.of Units �(� BASIC DESCRIPTION TOTAL QUANTITY WEIGHT CHARGES &Container Type H M UN or NA Number,Droper Shipping Name,Hazard Class,Pecking Group (weight,volume, {Subject RATE (For Cerner _ Gallons,etc.] Correction) Use Onlyt �" t I PLACARDS TENDERED:YES » NO REMIT �c.o.D.TO: Nate ca(1 i Where the rates or declared on value,shippers are required to state r hereby dadare that the contents of this nDD ESS spedihraly in writing floe agreed o:tleldared value d Me property.as fellows;'Rre mnsignmem era fully and accurately agreed or declared vale o1 the property Is hereby spetlMaily =ad by the shipper to described above by the proper shipping Co w Dom, C_O.D.FEE: be not exceeding par name and are classified, packaged, fV'■V7 PREPAID d (2)Where Ma applicable tarih provisions specify a limitation of Me tamers Gadilily absent marked and IabelledlplacaNed,and are - Amt. s COLLECT ❑ $ a release or a value declaration by Me shipper and the shipper does not release in all respects in propel condroon for ` me tamers liahillty or declare a value,the terriers liad']hy sinal be limisd to Me aslant hanspod according to appl'neb]e sWlect m semen 7 of the cantlltions�laq�shiyy�en--916 eativerad to ab TOTAL. provided by such prwisima.See NMFC]tem 172 ritematienal end national govemmental consignee wnhwl recourse on the cogpgroe!g1_ie ccr��or shell sign the CHARGES $ (3)commodities requiring special a addfional care or attention in handling or stosnng iatiars. loh—s star®nem. �,..e^'� �r� must be m marked and packaged as to ensure sale transportation.See Seoti,Mr 2 e pl regu Tha tamer shrill dirt— tlsilvery of this shlpmemldlhwl paymeN of 9 () freght_anq.alVetheFTa`wNf charges. FREIGHT CHARGES hem 380,Bills of Lading.Freight Bills antl Statements;d Charges and section 1(a)ei _ _ � RiEIWff PaEva10 Chir bm n charya Me Conal Tema and Conditions for a list of such articles Signdtttr8 J moot whe„r,�ad ata robe Isiawlua of Gwvgrwrl hl g dredmtl ❑ ooloor RECEIVED,suhjecl to the dassficatlons and tanfis in effect on the date or the ssue Iof In.ail or Lading. linstion and as to each party at any trine interested in an or any said property,that every servoe to the properly described above in apparent good order,except as noted(corderits and Condition o1 Cor~ be padtllmad homer r shall be Buhl,16 all the bill at lading forms and oundifons in the governing clan tents or packages unknown},marked.consigned,And destined es indieated above which said—trier airiartion an the rete d aNpm L or.word tamer being understood througttout trills contract as meaning any person or cwperafion n Shipper,hereby canities that he is familiar wNt ail the lading terms and conditions In the possession of Me property rhos,the mntradl agrees to carry 10 its usual place of deiNery at said dost- governing classification and the said leans and oonditions are hereby agreed to by the shipper and nation.if on is route,otherwise to deliver to waiter carder on the route to said desfinatiw,,it is rnukh apc>apted for himself and his assigns. ally agrsen as dip each earner d a!1 a any of.said properly over air or any portion of said route to des- TIPPER . i` aa 6'rAmd Schiz-of DW`C€'3-''•" CARRIER Adv Cho m1ca' l Tc iriansp* Inc- R PER : f,I PER DATE r� Permanent post-office address of shipper. STYLE F37&3 ®2012 LASELMASTER® 1900y 621-5906 www.labeimaster.COM aaiNrEloo oysv INK eiN'F�wRx J31NG S�'reel�N INe QY INK