COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

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THIS SHIPPING ORDER mustbelegiP n,in lnkrlrtdelihle Pencil,or in C,. rid in by the Agent. Shipper's No. Carrier SCAC Carrier's No. RECEIVED,subject to Individually determined rates or Contracts that have been agreed upon to writing between the carrier and shipper,it applicable,otherwise to the rates,classifications and rules tnat have been establelted by the carrier and are available to the shipper,on request:and all applicable stale and federal regulations; at , date from 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 ooriparry (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 o1 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 shad 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 r,It=ria f,Gr., r EFA VSE It v'4._L 4 1.. Shipper Street w rip, Z7-rStreet -7 oo W Destination N c o L v A e_-A Z y g Origin e A c C A zip a 3 -� Route Delivering Carrier Vehicle Number U.S.DOT Hazmat Reg.No. Description .low ---- t- � SYr+-r.tC4,C Ot • / I I Remit COD to: SubieC'I.Section 7 of toric sons.i'b 5 COD FEE: shipment a to be delivered to the consignee O D AMT: without recourse on the consignor, Ine Address: consignurshaIIsigntheroaowr,gstaterient Prepaid ❑ The carrier shaft not make delivery d In �h City: State: Zip: shipment without payment of freight and all W$ omen tawlut Burges. _ _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 hereby specifically stated by the stripper to be not exceeding S Per I (s i;Gure a consignor) ___ l Prepaid 0 Collect NOTE:Liability LlmHallon for loss or damage in this shipment may be applicable.See 49 U.S-C. -t 147 c 1 A and(a), , ,/ /jw BY SHIPPER []BY CARRIER This is to certify that the above-named materials are property classified,descnted,packaged,marked and labeled,and are in proper condition for transportation according to the appficalble regulafiom of the DRIVERS Departrnent of Tran ation. Per SIGNATURE: SHIPPER: 'VA _ �� t = j CARRIER: PER: r r '^ A ^ PER: S" DATE: EMERGENCY RESPONSE Monitored at all times the Hazardous Material is in transportation TELEPHONE NUMBER: ( - ) �� including storage incidental to transportation(172.604).