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B Copyright 2010 J.J.KELLER&ASSOCIATES,INC.*,Neenah,WI•USA•(800)327-6868•jikeller.com•Printed in the United States STRAIGHT BILL OF LADING-ORIGINAL-NOT NEGOTIABLE Shipper's No. 1 141 Carrier T�9c,-4 oPC •T4 �Dt3J t S 1=-JeV.SCAC ti ` fi Carrier's'No. RECEIVED,subject to individually determined rates or con acts that have been agreed upon in writing between the carrier and shipper,If applicable,otherwise to the rates.classifications and runs that have been established by the carrier and are available to the shipper,on request;and all applicable slate and federal regulations; at I%8d a w Sc S�) c ��. Tr 7- L -J 9' from G T 77tQ,,,r a t date the Property described below,in apparent good order,except as noted(cont and condition of contents of packages unknown),marked,consigned,and destined as indicated below,which Bald 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 destinabort,if on Its route,or otherwise to deliver to another carrier on the route to said destination.It is mutually agreed as t each carrier of all or an of said Property over ail or any portion of said route to destination,and as to each parry at any time interested in all or any of said Property that every service to be performed hereunder shell 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: Consignee De-r-Z Shipper � Tn to r Street 3 Street lyeoo w 4 Destination % Zi 9,S '7-7 Origin Zi 93s 7 Route Delivering Carrier vehicle Number U.S. DOT Hazmat Reg. No. Tey PEc A✓. ti Number and Type I D. of Packages HM Number Description of Articles lXGrti r, Ccy 1"J Subject to Section 7 of eondltiens.d this COD FEE: Remit COD to: shlpmont is to be delivered to the consignee COD AMT: without recourse on the consignor, the Address: �� cgnaignmshnll• awl"ge'atan,en' Prepaid ❑ The earner shall no Aa tl re. of this City:CitState: Zip: shipment without payment igh'and all C011ec other lawful charges. NOTE Where the rate is dependent on value,shr are regia slate specifically in writing TOTAL CHARGE -FREIGHT CHARGES- --the agreed or declared value of the property.Thea r declared value of the property is r,ereby specifically stated by the shipper to xceeding $ Per (Signature of Consgnon ❑ Prepaid ❑Collect NOTE Liability Limitation or damage in this shipment may be able.See 49 U.S.C. n 147p6(c)11 AA)_and •• a []BY SHIPPER BY CARRIER -., - r•,ei um aoa+e-named materials are properly classified,described,packaged,marks _ -e� esti ere m proper condition for transportation according to the applicable regulations of DRIVER'S a,EJG,pa2�tea'il 7ren_pf rtafirm Per r7p�J SIGNATURE: \\, SHIPPER: L J3'q 7oR=�/� ��'�"r rL G�2'G CS Y CARRIER: PER: DATE: PER: DATE: - EMERGENCY RESPONSE NAME OR CONTRACT NUMBER TELEPHONE NUMBER: OR OTHER UNIQUE IDENTIFIER: 436(Rev.9/10)