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tit WO' If oppn,rtwite CO ifoNignatn Hazardous Mattrialc o If
<br />UgiOn nejr.43600,1 tJr IIITR.VOMILOW1 of IIrim • .• moLhod for ,der:ti).tv htizartlaun rnotrrolIn no Rut: or Lading pvr 172 201(0(1)0,0 ot TrJe 49 rdgrrieJ 17001.41410fla .41,147 OlIn alapping harm-11005i matonda, Ore rJnurperit 0crullviti5n autement. ri soction 17:2.20-1(n) 01 rho Fodaral Regutorions,00 inthcntnd on the WI 01 Ludinn dot's 10for elrvrentonn hwy. •
<br />CHARGES
<br />Weight
<br />_jSub(ect to
<br />Gorrection)•
<br />Rote or Class ,
<br />r
<br />Note, Liability timitatiot
<br />or damage in this
<br />may be applicable
<br />(Thud States Code
<br />172 _;,)1:0 ,; I 1 ' •,• • .• •
<br />LGI,r. 172 201 ir.
<br />Prt;iiir il • ' 1...
<br />BILL OF LADING — SHORT FORM A-83876, 9013, 9014 T-3841, L3841, 3843 1-11
<br />HT BILL OF LADING - SHORT FORM
<br />uppers of harardous materials must enter 24-hour emergency
<br />telephone number under "Emergency Pespor4i Phone Number.
<br />,I—Not Negotiable
<br />bee fitigigezio zAw.DE_zey
<br />At A
<br />' itinebon Cikihiek/ea—
<br />itte:
<br />Bill of Lading No
<br />Shipper No
<br />Carrier No
<br />SCAC
<br />If the shipment moves between two ports by a REMIT
<br />3rrier by water, tha law requires that the bill of ladins C.O.D. TO
<br />ate whether weight is 'carrier's or shipper's weight • ADDRESS
<br />ote-Where the rote is dependent on value, shippers are required to
<br />ate specifically in writing the agreed Or declared value of the property
<br />se agreed or declared value of the property is hereby specifically stated
<br />the shipper to be not exceeding
<br /> per
<br />C.0.0 FEE:
<br />PREPAID 0
<br />\TOTAL
<br />COLLECTO $ CHARGES: $
<br />C.O.D.
<br />Arnt $
<br />Subject to Section 7 of the conditions if this shipment is to be deiivered to the consignee without FREIGHT CHAR
<br />recourse on the consignor the ccinsi ncr shrLsign the forowing statement
<br />The Check Appropriate
<br />charges.
<br />this shIpment without payment of freirS4ind oll other e comer shall riot make deli)/
<br />(Signature of CA.;nsTinor)
<br />01,)5 \ 0 Freight prepa
<br />0 Collect
<br />RECEIVED, subject to the classifications and lawfully filed tondo in effect on the data of the issue (1: Its Bill of Lading, the pioperty described °boa) in apparent good order, except as noted (
<br />condition of contents of packages unknown). marked. consigned, and destined as indicated aoove which sad corner (the wurd carrier being understood throughout this contract as meaning ox
<br />arporation in possession of the property under tho contract) agrees to tarry i.e its usual place of delivery BC said d,stination .1 on ea route, OU-iermse to deliver to onotlier earner on the rouu
<br />nation It ,s mutually agreed as to each corner of till or any of said property over all or any portion of said route to destination and as to each party at ony time interested in nil Or Orly Of
<br />diOt every service to be performed hereunder shall be subject to oll the terms and Conditions o' the Uniform Domestic Straight Bill of Lading set forth (11 in Uniform Freight ClassiticatIons .n
<br />OW hereof, if this is a roil or a rail-water shipment or (2) in the applicable motor corner classification or tanth th s ia a motor comer sllioment Shipper hereby certifies that Inc is foreria
<br />rrns and conditions of the said bill of lading, set forth in the clas.sification or tans( whic s governs the trarsoortaton of LI, s shipment. and the r.,.-1,c1 terms and conditors are hereby agreed
<br />r and accepted for himself and his assigns
<br />Zip Coda
<br />Emergency Response
<br />Phone Number
<br />Date "/Z Z7
<br />Zip Code
<br />Vehicle No
<br />(Nemo of Corned
<br />Kind of Packaging, Description of Articles C,',,,,s',1,-sr,s-raxsrina uorts,x orcxl, rrtiCo n hondlnu or.
<br />Special Morks and Exceptions snsrt nvvird and ita In mi,triro win tnint(rccuition with
<br />rd VI. &rick)! Motor Frog,* arIMAGOlion, luern 360
<br /> ita _do VI
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