COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

I THIS9PR-g �� N� q/p® I® pp® ®RpAt Ff i n acknowledgement that a bill of [doing has been Issued and is not the Original Bill of Lading, nor SHIPPER NO. ,` ®VF A'1P�ltl A6 tlV1 copy or duplicate, covering the property nameil`Ffetein(uiitl'1's Intended solely for tiling or record. x _ 1 X z „ s,.. . . t # CARRIER NO. &_ _ t + ';7}. '.> DATE �. _R SCAC r® FRoI� CONSIGNEE SHIPPER STREET ;Lr 1 , l' i _ STREET )ESTINATION STATE ZIP ORIGIN STATE ZIP ROUTE VEHICLE NUMBER U.S. DOT Hazmat Reg. No. r C_-w I _ „ , ' i 1 3 ; ;w t o ± T iia? r P d. yC _ Id €' r , 1 _,: cc . I lid?'d ` = 1 ! l d X S / !� / ' a i f i ( � trt G l t ,!ir! f a .l„ ',1. i _nr YIK; J1 t'ee Lie- I Zhyl Subled to Section 7 of conditions, it this C®® FGC : 3emlt COD t0: shipment is to be delivered to the consignee COD AMT: thou' remorse on the consider,ider, Ne consignor Cddress' shall sign the refinery statement Prepaid ❑ me carder shall not mare dell�ery of this Aty State: Zip: sltlpmam .amom pat"^`m o"'nig^t and all order Collect ❑ � labial charges. (OTE: Where the rale 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 property Is hereby pacifically stated by the shipper to be not exceeding $ Per Signature of Const nor ❑ Prepaid ❑ Collect ECEIVED, subject to individually determined rates or werac'smet have been agreed upon In Writing between the carder andhiper, if applicable, othemise to the rates, classifications and rules that have been established by the carder and are avail the shipper, on request; and all applicable state and federal regulations; the Property described above, In apparent good order, except on noted (contents and condition of contents of packages unknown), marked, consigned, and destined as Indies(( e which said company (the word company being understood throughout this contract as moaning any person or cor omllon in possession of the property under the contract) agrees to carry to delivery at said destination, If on its route, or otherwise :liver to another carder on me route to said destination. It Is mutually agreed as to each carder of all or any of said Property over all or any page of said route to unattended and as to each party or any time interested in all or any of said PropeM that eve ever to be performed hereunder shall be subject to all the considers,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 himsed and h ,signs OTE: Liability Limltallon for loss or damage in this shipment may be applicable. See 49 U.B.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 is in proper condition for transportation according to the applicable regulations of the Department of Transportation PER: (HIPPER: / )I. 1+ Y t-, 1fisd Sits€ & . w3ut ) 3f:" CARRI .EFr..t.�L:,g lPgS r€ CCA ;v't,`rXl 7747 Id lt r PER: DATE: EMERGENCY RESPONSE NAME OR CONTRACT NUMBER rEt_EHHONE NUMBER : OR OTHER UNIQUE IDENTIFIER: !267 (Rev. 3117)