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THIS MEMORANDUMan to wtowledgemerd that a bill of lading has been Issued and not Original Bill of lading,nota copy er duplicate,eevering the property named here'vy and is intended solely for filling w racard. Shipper's No. Carrier ;�a ..�3 : �i�, _ `-e �.5 ._.--. SCAC Carrier's No. RECEIVED,subject to individually determined rates or contracts that have been agreed upon in writing between the carrier and shipper,if applicable,otherwise to the rates,Gassificatiorts and rules that have been established by the carder and are available to the shipper,on request;and all applicable state and federal regulations; at date from' • fi� �� F� i= 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,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 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: ,. l Const nee ;��t , , ': f �w: Shipper Street Street Destination BENIA cr„ , �.._. Zi Origin Zi ' Route GALi t{P33016W Delivering Carrier Vehicle Number U.S. DOT Hazmat Reg. No. Number and Type HM 1.D. Description of Hazard • TotalQuantity of Packages Number (miss.volume �r (SLIbIPCIt to Class Grp. Rate activlty� correction) Remit COD to: Subject t0 Section 7 of conditions,it this A CDD FEE: shipment is to be delivered to rite consignee r -O D AMT. Address: without recourse on the consignor, the V A consignor shall sign the following statement: Prepaid The career shall net make delivery of this Y CI - State. zI shipment lchagesaymenl of treighl antl all Collect ❑$ 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 is thereby specifically stated by the shipper to be not exceeding $ Per (signature of Consignor) 1$ ❑ Prepaid ❑Collect NOTE:t.tabtlity Lbr Mahlon for loss or damage In this shipment may be applicable.See 49 t1.S.C. 1 A and B. s f BY SHIPPER BY CARRIER This his t 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 • rDRIVER'Sthe Department of Transportation. Per TURE: SHIPPER:�� i' �r�;,_fr F �' ' CARRIER. a , t PER: DATE: PER: DATE: EMERGENCY RESPONSE NAME OR CONTRACT NUMBER TELEPHONE NUMBER: i-'+"?` "a" .``- OR OTHER UNIQUE IDENTIFIER: 969(Rev.3117)