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t <br /> �! s ■ i * ■ ■ i i i ■ i i ! ! ! <br /> Copyright 2017 J.J-Keller d Associates,Inc,•Neenah,III•,JAeller.com•(Bop)327.6868•Printed in Hta USA <br /> a � • <br /> STRAIGHT BILL OF LADING-ORIGINAL-NOT NEGOTIABLE <br /> Shipper's No. ?IJ <br /> Carrier Aa,-AIA V 5�.�CAC Carrier's No. <br /> IAIJ <br /> f1ELElVEQ.subiect to rndmdually dete",riod rares I chs shat ham nil agreed upon in wneng between the carrier a ablpper,if applicable,otherwise to the rates,cWWrcatlors and renes that have been <br /> e5tablighed by the earner and are BYAIlobIA lo Ivt9 efllpper,on request;end all applicable scale and rederat regurallons; <br /> at J:�Aetn Ste.e:rc OeJ r �9 date .2 from L <br /> Ira Property described below.�n aAPar<+nl <br /> gwtl order.except as noted Icarian s and condition of con renes or peokages unknown consigned.and desungd as indicated below,which said company <br /> [the wend company being understood throughqul this taxtvact as mean+n an )�marked, <br /> Mule.or off"w" e m defter to another carrier on die rouse to card desrinalia�yl[[is SOA or corporation <br /> as to POWDcarrier of all or�Und9r�0ontrany agrees to carry to delivery al said destination.If on Its <br /> dant parry at any fare interested in all or any I say property that every service to be Pedottbed hereunder arae be any of said Property over all or any portion of said route to destination,and as!o <br /> converted,+nctudng rho condlrl n on the back rte+ddl,whxh are hem6y agreed to by are shlppl9r and accepted!oralt 6A l blestarid ato;I II ft.condiltons not Prohl7NW by 1I Whether premed M wrinen,herein <br /> TO: <br /> FROM: <br /> Consi tree <br /> t la. 5hi er <br /> street /� ' Street <br /> Destination . ,nr <br /> Route 5+24& 1pf zhi 5.1$a Ori in Zi 3S-7 <br /> t7eli►rering Carrier Vehicle Number 11,&DDT Hazmat Reg. No. <br /> Lf fill <br /> 3emit COD to: 5 et m Seeean 7 at emtdiul it in COD FEE. <br /> shrpmen o oe denvernd to Ito conrrgnee ��� AMT: <br /> ,ddress: wllhour recd on ere eonxtgnor, the <br /> �r w�I not ^A sratof ame this Prepaid ❑ <br /> State: Zl IWPment rnt+louf paymept of rrmght a <br /> ]Tr Where the rete is depen r dher taw}w charges Collect ❑ <br /> agreed or declared value of ore p e agree <br /> rp slate tl value of the pa of]he p roperty is in writing TOTAL C <br /> airy Wall slatted by Ilia r to lye rcpt ext+eeding$ RGES: <br /> TE:Liability Lim- or lora or damage In fhts ahlphI may be appfidabte_ C 1 twe or co 6 aid ❑Collect <br /> c 1 A <br /> ,I L <br /> c,a'n,r. ri..0:nll irv,p:W1IYr uas irl descnced.Packaged. •• F ❑By SHIPPER SYCAMMEIR <br /> Arr9 M.lr+�; r:•J.r.x rr+��.r.r CvndxePn In•Irgrrypirtanpr dCCW.Jjnq ip ft appl, jr, <br /> t n-rd*,ens�uhyrw� r's+ aAIVER'S <br /> SIGNATURE: <br /> .PPER: LCARRIER: <br /> I: DATE: 2' <br /> PER: <br /> DATE: <br /> RGENCY RESPONSE �U NAME OR CONTRACT NIJMBEfI <br /> PHONE NUMBER: �..C7 r����� OR OTHER IINInIm ing:NTMIr-n• �� - r— <br />