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THIS MEMORANDUM Is an acknowledgement that a bill of lading has been issued
<br /> d "s Isnot tl Origi(` BI' ofLading, nor SHIPPER NO.
<br /> copy or duplicate, covering the property named.heedropP Y filing or record.'? "s CARRIER NO.
<br /> __..., ,.,,......t o,,. .. .
<br /> . . . .:_. .. DATE
<br /> At .R SCAC j
<br /> ro FROM
<br /> )ONSIGNEE SHIPPER
<br /> MA ,091.` I 42D-1I
<br /> >TREET �.i_' r r STREET z. r °J°,fa
<br /> �;t..p jit , 'til t r IIT':. a s•\ `:
<br /> )ESTINATION STATE ZIP ORIGIN STATE ZIP
<br /> IOUTE p*,
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<br /> U.S. DO-r Hazmat Reg. No.
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<br /> ;emit COD to: shipmames'to b deliv ref to Ina Ong, If COD FEE : '........
<br /> withoutm on use consignor, the mr,sigmr COD AMT: '..
<br /> tddress: shelf sgn femse e followingslatemenl: Prepaid ❑
<br /> The carrier shall not make delivery of this l
<br /> ;Ity: State: Zip: iwfinent Ye snm payment of freight and an mnar � Collect ❑ $
<br /> OTE: where the rale is dependent on value, shippers are required to stale specifically m writing the TOTAL CHARGES: FREIGHT CHARGES'
<br /> greed or declared value of the properly. The agreed or declared value of the property Is hereby dd�� '
<br /> eciflcally stated by the shipper to be not exceeding $ Per Signature of Consignor) W ❑ Prepaid ❑ ColieCt
<br /> ECEIVED, subject to Individually determined rates or contracts that have been agreed upon in acting between the carder and shipper, it applicable, otvidev eto the rates, classifications and miss that have been established by the carder and are availed
<br /> the shipper, on request; and all applicable state and federal regulations; the Properly described above, in apparent good order, except as noted (contents and condition of contents of packages unknown), marked, consigned, and destined as indicate
<br /> love which said company (the ward company being understood throughout this regarded as meaning any person or corporation In possession of the properly under the seemed agrees to carry to delivery at said destination, if on its route, or otherwise
<br /> :liver to another tamer on the route to said destination. It is mutually agreed as to each carder of all or any of said Property over all or any gonion of said route to destination and as to each party at any time Interested In all or any of said Property that eve
<br /> :Moe to be performed hereunder shall be accost to all the conditions not prohibited by law, whether printed or written, herein contained, including the conditions on the back hereof, which am hereby agreed to by the shipper and accepted for himself and h
<br /> signs
<br /> OTE: Liability Limitation for loss or damage In this shipment may be applicable. See 49 U.S.C. 14706(c)(1)(A) and (9),
<br /> his is to certify that the above-named materials are properly classified, described, packaged, marked, and labeled, and .
<br /> re in proper condition for transportation according to the applicable regulations of the Department of Transportation PER:
<br /> t3 ' i” Tit 8 I
<br /> p t ee %( Ih w �r,O�i Ct._ rsof:
<br /> HIPPER
<br /> PER:
<br /> �d: CARRIER: C�s1r`sldra r �.r€fit 6P ,ttyu 3 a )9
<br /> PER: r /
<br /> C �� b � _ �(r ,� t 'Y' . � f (i7� �l lot)
<br /> DATE:
<br /> EMERGENCY RESPONSE NAME OR CONTRACT NUMBER
<br /> TELEPHONE NUMBER: OR OTHER UNIQUE IDENTIFIER:
<br /> 1267 (Rev. 3/17)
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