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0 CoPYhght 2010 J.J.KELLER 8 ASSOCIATES,INC®,Neenah,WI•USA•(800)327-6868•pkeller.com•Printed in the United States STRAIGHTBILLOF LADING-ORIGINAL-NOT NEGOTIABLE Shipper's No. ej Comer /ra 1�,�, T„ sear SCAC N�/ y SSS RECEIVED,subject to In�ir wally determined rates or contra is that have been a reed u on in writin between the carrier and shi er if Cacaabe�S otherwise to the rates,classifications and rules that have been by the carrier and are available to the shipper,on request;and all applicable state and federal regulations; Pp Pp iat / .It r date_ 7- 17 - ta/ from G the Property described below,in apparent good ortler,except as noted(contents d 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 parry al 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 condRions on the back hereof,which are hereby agreed to by the shipper and accepted for himself and his assigns. TO: FROM: Consi nee 1 R _ T �r 5 i Shipper L T 17�1er 197 Street a7 J tt- Street Destination C4 Zi '735-7:Z' Zi S,5-7 Route Ori in T 9 I Delivering Carrier Vehicle Number U.S.DOT Hazmat Reg.No. Number and Type 1.D. Hazard Pkg. (mass.Volume.or (subject 10 Total Quantity Weight of Packages HM Number Description of Articles Class or Class Grp. admily) correction) Rate I 40 P1�s-ct LY - JJ AJ r-'s 0-0 3q Jac) $Ub,ecl to section 7 of cohdillone,It Ihia COD FEE: Remit COD to: ah,pmenl Is to be s delivered to c one consignee COD AMT: haul recourse n Ina con5�gnor,me cons i nthelollomngslalemenc Prepaid ❑ Address: a corner S e del-ly of MS tate: Zip: pment without payment o rid all City, olherlawlul charges. t,CiTE�Where the rate Is dependent on value,shlppe o state specifically in writing A FREIGHT CHARGES: the agreed or dedared value of the property. eed Glared value of the property is hereby specifically stated by the shlpp not exceeding$ Per (Signature of Consignor) 1P Prepaid ❑Collect •s NOTE:Liability Limitation as or damage in this shipment may be a able.See 49 U.S.C. BY SHIPPER RRIER ;479 c INA;and _ +e r:ameIf materials are property dassltled,described,packaged,mark s DRIVERS for transpo�on according to the applicable regulations of SIGNATURE: CARRIER: -r/ 1 OC s SHIPPER:� DATE: I -19 PER: DATE: --�- PER: 1 -� NAME OR CONTRACT NUMBER EMERGENCY RESPONSE TELEPHONE NUMBER: OR OTHER UNIQUE IDENTIFIER: 436(Rev.9/10)