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THISTHISMEMORANDUM i n acknowledgement that a hill of lading has been Issued and is not the Original Bill of Lading, nor SHIPPER NO. MEMORANDUM 8"'9P@®ntl WV9gi copy or duplicate, covering the property rommodherelicand is Intended solely for filing or record. ' s CARRIER NO. . . .. . .. . .. . . . . ... . . a,.{ v.. : GI c{.'ti.' e i v , „ t; I T .; ) :];? . . . _ . . DATE Is _R SCAC PO It FROM CONSIGNEE SHIPPER Cit <e� _+ `I<t ._ a'.. I) s ? _ , dtc al `r`a 1_ iTREETF jf t ul..>; STREET , 073 tf 1I IF i 1 if )ESTINATION c '�� f' ` C>�l �� STATE ZIP ORIGIN Tt �' r IF `" tSTATE ZIP ROUTE VEHICLE NUMBER U .S. DOT Hazrnat Reg. No. P r4 i'F 6 - P . ,I urs unktIW _ da -ttps !� IF C21P I c 5 5 tii2� If 1`310 (IF (Soyo� �i.a )C i rG / )I1 to �l'? _ I t .ten, t r gat iaefi(-E. d L kSa �a-�)c 50 ld It- IF. ycr ' ore,”' W10..urPL 3G �� I )c ',soF{ U I:>863 ,o, hait,iY rabies, Pf / y,. 30 / F{ d- , Qi; 1lgf7aIC - 1 =t +� Rr Subject to Section 7 of conditions I( this COD FEE • ;emit COD to : shipment Is to be delivered m the consignee • oppose recourse on Ne consgnor, the consignor COD AMT: (ddYBSS: shall sign t o following statement Prepaid ❑ shipment mhout payment off eight e boner shall not Make lenU all other p of this II State: Zip: gee. $ Collect ❑ $ OTE: Where the rate Is dependent on value, shippers are required to state specifically in writing the TOTAL CHARGES: FREIGHT CHARGES: greed or declared value of the property. The agreed or declared value of the properly is hereby d• Prepaid E] Collect ecificaliy stated by the shipper to be not exceeding $ Per Sinawre of consignor W ECEIVEe, subject to individually determined rates or contracts that have been agreed upon in writing between the carder and shipper, if applicable, amendable the rates, classifications and rules that have been established by the carrier and are revelab Me shipper, an request; and all applicable state and federal regulations; the Property considered above, in apparent good order, except as noted (contents and condition of contents of packages unknown), marked, consigned, and segment as indicate a which card company (the word company being wideatootl throughout this contact as meaning any person or corporation in possession of the property under the contract) agrees to carry to delivery danger destination, if on Its route, or otherwise liver to another carder 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 Porion of said route to destination and as to each party at any time interested in all at any of cold Property that eve merce 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 In vsigns. OTE: Liability Limitation for loss or damage In this shipment may be applicable. See 49 U.S.C. 14706(c)(1)(A) and (B). - his is to certify that the above-named materials are properly classified, described, packaged, marked, and labeled, and re in proper condition for transportation according to the applicable regulations of the Department of Transportation PER: T �� ° , � � HIPPER: : T ` " 5 PER: . i DATE: .��:�� Sri U EMERGENCY RESPONSE NAME OR CONTRACT NUMBER TELEPHONE NUMBER: c[OR OTHER UNIQUE IDENTIFIER: 267 (Rev. 3117) v