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STRAIGHT SILL OF LADING —ORIGINAL— NOT NEGOTIABLE Shippers No. CarrierSCAC Carrier's No. RECEIVED,subject to individually determined rates or contracts that have been agreed upon in writing between the carrier and shipper,it 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 state and federal regulations; at , date from 23 25/ 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,whic 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 deliveryat 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: Consignee Shipper le-D Street , , �� Street ✓. Destination zip IV—,VVIV-, VV Origin ✓ Zi pe,71 Route Delivering CarrierVehicle Number U.S. DOT Hazmat Reg. No. 1� .12 Remit Remit COD to: Subject to Section r d condJo is COD FEE: shipment is to be tleifvered to the COD q r.rr�- without recourse on the cone N'v' Address: consignor shall sign the following stPrepaid ❑ The carrier shall not make deisCity: State: ZIp, shipment without paymem of Irell � CcllectCOD otherlawful 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 ishereby specifically stated by the shipper to be not exceeding $ Per (signature of Consignor $ ❑Prepaid ❑Collect NOTE:Liability Ltmiiation for loss or damage in this shipment may be applicable.See 49 U.S.C. -ti 14706 c 1 A and 8. .® ® n SY SHIPPER []BY CARRIER This is to certify that the above-named materials are properly classified,described,packaged,marked and labeled,and are in proper condition for transportation according to the applicable regulations of P ® DRIVER'S the Department of Transportation. Per SIGNATURE: SHIPPER: ♦C CARR!f;1: Uri PER: ' : DATE: _rl~ PSR` ' '" '` DATE: s B17ERCEI\M RESPOHS� QQ .� N1,-AM-E&'SJR C0NTr Q T tV�4V��E F I',_EPHONE NUMSL.R: OR ti, fir- ?r - i 9Pi R 3-BLS-C3 969(Rev.9/10)